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Cost-effectiveness of two models of management for patients on chronic warfarin therapy--a Markov model analysis

Joyce H S You1, Fredric W H Chan, Raymond S M Wong

  • 1Centre for Pharmacoeconomics Research, School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong. yceyou@cuhk.edu.hk

Thrombosis and Haemostasis
|December 4, 2003
PubMed

Insights

Anticoagulation clinics (AC) are more cost-effective than routine medical care (RMC) for managing warfarin therapy. AC services reduce adverse events and healthcare costs, benefiting public health organizations.

Area of Science:

  • Health Economics
  • Pharmacotherapy
  • Public Health

Background:

  • Resource allocation for anticoagulation clinic (AC) services is a key concern for healthcare providers.
  • Most anticoagulated patients in Hong Kong receive routine medical care (RMC) rather than AC management.
  • A lack of local cost-effectiveness data for AC services may contribute to this trend.

Purpose of the Study:

  • To compare the clinical and economic outcomes of anticoagulated patients managed by AC versus RMC.
  • To evaluate these outcomes from the perspective of a public health organization in Hong Kong.

Main Methods:

  • A 10-year Markov model simulated economic and clinical outcomes for chronic warfarin therapy.
  • Transition probabilities were sourced from existing literature.
  • Resource utilization data were collected from Hong Kong patients in AC and RMC settings.
  • Sensitivity analysis was performed to assess model robustness.

Main Results:

  • The AC group experienced fewer events (9.5 per 100 patient-years) and lower direct medical costs (USD 840 per patient-year) compared to the RMC group (19.3 events and USD 1,179).
  • Model outcomes were sensitive to variations in major bleeding probability within the AC group.

Conclusions:

  • Coordinated care in anticoagulation clinics is more cost-effective than routine medical care for warfarin management.
  • AC services offer a favorable economic and clinical profile for public health organizations in Hong Kong.

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