Anticoagulation management in primary care: a trial-based economic evaluation

Abstract

The demand for anticoagulation management is increasing because of a widening of the indications of treatment. A primary care clinic using near-patient testing and computer decision support software is one model of care to meet this increased demand. The study aimed to determine the cost and cost-effectiveness of primary care-based anticoagulation management in comparison with 'traditional' hospital care-based provision by means of a cost-effectiveness analysis using data from a Birmingham-based multicentre randomized controlled trial. The costs per patient per year in primary care were pound170 [95% confidence interval (CI) pound149-190] vs. pound69 (95% CI pound57-81). Sensitivity analysis demonstrated that the cost in primary care could be reduced to under pound100 per patient per year under plausible changes in the variables. Primary care provides similar levels of control to secondary care for patients on anticoagulation therapy. There is an increased cost of managing patients in primary care and at no point did primary care become a lower cost option than secondary care. Local decision-makers need to assess the increased cost of primary care anticoagulation management in terms of the potential reductions in high-cost serious adverse events.

The cost-effectiveness of point of care testing in a general practice setting: results from a randomised controlled trial

“…This contrasts with the results of a Belgian study which found the use of a PoCT device for anticoagulant management combined with a multifaceted education intervention was dominant to usual care in GP [19]. Anticoagulant management in GP using PoCT, was also found to be more costly by Parry et al [22]. This UK study investigated the cost-effectiveness of PoCT, using data obtained through an RCT of PoCT and computerised decision support to manage anticoagulation therapy in GP.…”

“…Comparing the results of the cost and the cost-effectiveness analyses for this Trial with other studies is difficult because of the limited research in this area [16-22]. Those studies that do exist are also limited in their scope and design.…”

“…Only one study directly compared GP PoCT with usual care using laboratory testing [21]. Moreover, while some studies investigated cost-effectiveness, [16,19,22] only one reported the incremental cost-effectiveness ratio [19]. …”

How much does international normalized ratio monitoring cost during oral anticoagulation with a vitamin K antagonist? A systematic review

“…Studies conducted in specialist hospital clinics (8 studies) showed INR monitoring costs that ranged from $11.75 for drawing blood and measurement of prothrombin time (Menzin et al. , 1995) to $45.57 for a new‐patient appointment (Parry, Fitzmaurice & Raftery, 2000). For studies conducted in general practice (4 studies), the range of costs was $24.19 for a GP taking a blood sample with hospital analysis and dosing (Jowett et al.…”

Quality assurance for point‐of‐care testing of oral anticoagulation: a large‐scale evaluation of the Hemochron Junior Signature Microcoagulation System

“…Data are conflicting on potential cost benefits; however, the most recent UK data suggest no cost saving with community monitoring, except in domiciliary patients (Fitzmaurice, Hobbs & Murray, 1998; Lafata et al. , 2000; Parry, Fitzmaurice & Raftery, 2000). POC testing devices may also give selected patients the opportunity for self‐testing and self‐management.…”