Cutting Costs and Enhancing Care: The Financial Burden of Factor VIII Testing in Thrombosis and Stroke Workup

Introduction:

Elevated factor VIII is often linked to increased thrombosis risk and has been used as a tool to measure outcomes and prognostication in thrombotic events, but its direct contribution remains uncertain. Current guidelines suggest limited benefit in testing of factor VIII levels in thrombophilia(s) and stroke(s). Despite this, factor VIII testing is frequently performed during routine workup of venous thromboembolic events (VTEs) and cerebrovascular accidents (CVAs). Our study examines the financial impact of unnecessary and clinically irrelevant factor VIII testing in these scenarios.

Methods:

At our institution, we performed a retrospective study approved by the Institutional Review Board (IRB), analyzing data from 462 patients who underwent factor VIII level testing from December 2019 to December 2022. We excluded patients whose tests were performed for reasons other than evaluating thrombophilia or cerebrovascular accidents (CVAs) and analyzed data for 157 patients. Our data collection encompassed patient demographics, indications for testing, and insurance coverage. This information was used to assess the financial impact on our institution related to the unnecessary testing of factor VIII levels in patients with an increased risk of thrombosis and stroke.

Results:

The median age of testing for factor VIII levels was 34+/-7 years, with females (96) constituting 61.1% and males contributing (50) 38.9%. Factor VIII levels were tested for 61 patients with Transient Ischemic Attacks (TIAs) and CVAs and in 96 patients with VTEs. Out of all the 157 patients tested, 27 were covered by Medicare, 71 by Medicaid and 59 benefitted from private-based insurance. In-house testing for this gene costed approximately $180 per test in 2019, with the cost inflation up to $260 after 2020.

Conclusions:

Over a three-year period, our analysis revealed an expenditure of approximately $30,000 USD on factor VIII level testing as part of the diagnostic workup for thrombophilia and stroke, despite insufficient clinical evidence supporting its necessity. This study aims to disseminate these findings within our institution to minimize clinically unwarranted testing, enhance patient outcomes, and optimize the cost-benefit ratio by educating clinicians. By addressing this, we hope to reduce the financial burden on healthcare systems while adhering to clinical guidelines.

No relevant conflicts of interest to declare.