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Anticoagulation clinics and patient self-testing for patients on chronic warfarin therapy: A cost-effectiveness
J E Lafata1, S A Martin, S Kaatz
1Henry Ford Health System, Detroit, Michigan 48202, USA.
Insights
Patient self-testing for warfarin management is more cost-effective than usual care or clinic testing. This approach reduces thromboembolic and hemorrhagic events, offering significant overall cost savings.
Area of Science:
- Pharmacoeconomics
- Health Services Research
- Clinical Pharmacy
Background:
- Chronic warfarin therapy requires diligent anticoagulation monitoring.
- Traditional management includes usual care and specialized anticoagulation clinics.
- Patient self-testing offers a potential alternative for managing warfarin therapy.
Purpose of the Study:
- To evaluate the cost-effectiveness of anticoagulation clinic care versus patient self-testing for chronic warfarin therapy.
- To compare health and economic outcomes of three management approaches: usual care, clinic testing, and self-testing.
Main Methods:
- A 5-year Markov model was utilized for the economic evaluation.
- Data from published literature and a large health system informed model assumptions.
- Health outcomes (thromboembolic and hemorrhagic events) and costs were assessed.
Main Results:
- Anticoagulation clinic testing reduced events by 1.7 thromboembolic and 2.0 hemorrhagic events per 100 patients compared to usual care.
- Patient self-testing further avoided 4.0 thromboembolic and 0.8 hemorrhagic events compared to clinic testing.
- Patient self-testing demonstrated the greatest cost-effectiveness, yielding overall cost savings.
Conclusions:
- Both anticoagulation clinic testing and patient self-testing offer superior health outcomes compared to usual care.
- Patient self-testing is the most cost-effective strategy for managing patients on chronic warfarin therapy.
- Self-management empowers patients and reduces healthcare expenditures.
Abstract:
This study was intended to evaluate the cost-effectiveness of anticoagulation clinic care and self-testing for the management of patients on chronic warfarin therapy. Using a 5-year Markov model, we evaluated the health and economic outcomes associated with each of three different anticoagulation management approaches: (1) usual care, (2) anticoagulation clinic testing with a capillary monitor, and (3) patient self-testing with a capillary monitor. Data available in the published literature and data from a large health system were used to develop model assumptions. Model results indicate that over a 5-year period, compared with usual care, anticoagulation clinic testing results in a total of 1.7 fewer thromboembolic events and 2.0 less hemorrhagic events per 100 patients. Another 4.0 thromboembolic events and 0.8 hemorrhagic events are avoided with patient self-testing compared with anticoagulation clinic testing. In addition to the health advantages of these strategies, both also have cost advantages. When the costs incurred by provider organizations and patients are considered, patient self-testing is the most cost-effective alternative, resulting in an overall cost saving.