Effectiveness and costs of a stepwise versus an all‐in‐one approach to diagnose mild bleeding disorders.

Summary: The diagnostic work‐up of patients referred to the haematologist for bleeding evaluation is performed in a stepwise way: bleeding history and results of screening laboratory tests guide further diagnostic evaluation. This can be ineffective, time‐consuming and burdensome for patients. To improve this strategy, the initial laboratory investigation can be extended. In a model‐based approach, effectiveness and costs of a conventional stepwise versus a newly proposed all‐in‐one diagnostic approach for bleeding evaluation were evaluated and compared, using data from an observational patient cohort study, including adult patients referred for bleeding evaluation. In the all‐in‐one approach, specialized platelet function tests, coagulation factors, and fibrinolysis tests were included in the initial investigation. Final diagnosis, hospital resource use and costs and patient burden were compared. A total of 150 patients were included. Compared to the stepwise approach, in the all‐in‐one approach, 19 additional patients reached a diagnosis and patient burden was lower, but total costs per patient were higher [€359, 95% bootstrapped confidence interval (BCI) 283–518, p = 0.001]. For bleeding evaluation of patients referred to the haematologist, an all‐in‐one diagnostic approach has a higher diagnostic yield and reduces patient burden, at a higher cost. This raises the question what costs justify the diagnosis of a bleeding disorder and a less burdensome diagnostic strategy. [ABSTRACT FROM AUTHOR]