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

Floor C J I Heubel-Moenen*, Loes E M Ansems, Paul W M Verhezen, Rick J H Wetzels, Rene G M van Oerle, Ron J M H E Straat, Karyn Megy, Kate Downes, Yvonne M C Henskens, Erik A M Beckers, Manuela A Joore

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


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.

Original languageEnglish
Pages (from-to)792-801
Number of pages10
JournalBritish Journal of Haematology
Issue number6
Early online date28 Nov 2022
Publication statusPublished - Mar 2023


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