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Anticoagulation management in primary care: a trial-based economic evaluation
D Parry1, D Fitzmaurice, J Raftery
1Health Economics Facility, University of Birmingham, Park House, Edgbaston Park Road, Edgbaston, Birmingham, UK. d.j.parry@bham.ac.uk
This study compared the costs of managing anticoagulation therapy in primary care versus hospital-based settings. Using data from a randomized trial in Birmingham, researchers found that primary care was more expensive per patient per year. Despite higher costs, primary care provided similar control over anticoagulation as hospital-based care. Sensitivity analysis showed costs could be reduced under certain conditions, but primary care never became a lower-cost option. The study suggests decision-makers should consider the trade-offs between cost increases and potential benefits in reducing serious adverse events.
Area of Science:
- Primary care economics
- Anticoagulation therapy management
- Healthcare cost-effectiveness analysis
Background:
Healthcare systems are facing rising demands for anticoagulation management due to broader treatment indications. Traditional hospital-based models remain common, but alternative approaches are being explored. Prior research has shown that hospital-based care is resource-intensive and may not always be the most efficient. The need for alternative models has driven interest in primary care-based systems. Birmingham-based trials have examined these models, but cost data remains limited. This study addresses a knowledge gap in cost comparisons between care settings. No prior work had resolved the economic implications of primary care-based anticoagulation. The study's contribution lies in its trial-based economic evaluation.
Purpose Of The Study:
This study aimed to compare costs and cost-effectiveness of primary care and hospital-based anticoagulation management. The researchers focused on a Birmingham-based trial to assess economic outcomes. They used a randomized controlled trial to generate comparative data. The goal was to determine if primary care could reduce costs while maintaining quality. The study also examined sensitivity of cost estimates to variable changes. Researchers sought to quantify the financial implications of each model. They wanted to inform local decision-makers about trade-offs between cost and outcomes. The study's design allowed for a direct comparison of care models.
Main Methods:
The study used a multicenter randomized controlled trial in Birmingham to collect data. Researchers compared primary care and hospital-based anticoagulation models. They measured costs per patient per year in both settings. Cost-effectiveness analysis formed the core of the evaluation. The study included near-patient testing and decision support software in primary care. Sensitivity analysis tested the impact of variable changes on cost estimates. Researchers calculated 95% confidence intervals for cost comparisons. The trial-based data allowed for precise economic modeling.
Main Results:
Primary care management cost £170 per patient per year (95% CI £149-190). Hospital-based care cost £69 per patient per year (95% CI £57-81). Sensitivity analysis showed primary care costs could drop to under £100 per patient. Both models provided similar levels of anticoagulation control. Primary care never proved a lower-cost option than hospital-based care. The study found no scenario where primary care was more cost-effective. Researchers observed consistent control outcomes across both settings. The data suggests higher costs in primary care despite equivalent quality.
Conclusions:
The study found primary care anticoagulation management is more expensive than hospital-based care. Both models achieved similar levels of control for patients. Sensitivity analysis confirmed cost estimates remained stable under variable changes. The authors suggest decision-makers should weigh cost increases against potential benefits. No prior work had resolved the economic implications of primary care models. The findings highlight the need for careful cost-benefit analysis. Researchers propose that local factors may influence cost-effectiveness outcomes. The study does not suggest primary care is a lower-cost alternative.
Frequently Asked Questions
Primary care costs £170 per patient per year, while hospital-based care costs £69 per patient per year.
Both models provided similar levels of anticoagulation control, according to the study findings.
Sensitivity analysis showed primary care costs could drop to under £100 per patient under plausible variable changes.
It helps decision-makers assess trade-offs between higher costs and potential reductions in serious adverse events.
The 95% confidence intervals indicate the range within which true costs likely fall for each care model.
The authors propose local decision-makers should evaluate increased costs against potential benefits in reducing adverse events.