A geospatial model to determine the spatial cost-efficiency of anticoagulation drug therapy: Patients' perspective

Area of Science:

• Pharmacoeconomics
• Health Services Research
• Geographic Information Systems (GIS)

Background:

• Atrial fibrillation (AF) management requires anticoagulation to prevent thromboembolic events and stroke.
• Warfarin and direct oral anticoagulants (DOACs) are primary anticoagulation therapies.
• Understanding the spatial costs associated with these therapies is crucial for optimal patient management.

Purpose of the Study:

• To analyze the spatial costs of warfarin versus DOAC therapies for atrial fibrillation patients.
• To determine the least-cost market areas for each anticoagulation therapy within the study region.
• To model the influence of patient proximity to monitoring, visit frequency, travel costs, and time loss on therapy selection.

Main Methods:

• Utilized concepts of spatial costs and market area formation.
• Incorporated patient travel, time-loss, and medication costs into a geospatial model.
• Employed Geographical Information Systems (GIS) methods for spatial analysis.

Main Results:

• Warfarin therapy is the least costly option for AF patients residing near INR monitoring sites with fewer than 15 annual visits.
• DOAC therapy becomes the more economical choice for patients needing frequent INR monitoring or living farther from sample collection points.
• Patient-specific factors like travel distance and time loss significantly impact the overall cost-effectiveness of anticoagulation therapies.

Conclusions:

• The selection of anticoagulation therapy (warfarin vs. DOAC) is influenced by a patient's location relative to monitoring services and the frequency of required monitoring.
• Geospatial modeling effectively illustrates the economic trade-offs between different anticoagulation strategies.
• Physicians should consider patients' travel and time-loss costs when deciding on the most appropriate and cost-effective anticoagulation therapy.