Patient and healthcare provider burden due to conventional measurement of the international normalized ratio: From a multi-dimensional perspective

Abstract

In this study, we aimed to investigate the healthcare burden associated with hospital visits for international normalized ratio (INR) measurement from a multi-dimensional perspective.Patients and methods: A total of 415 patients (198 males, 217 females; mean age: 54±12.7 years; range, 14 to 84 years) who were admitted to the cardiovascular surgery (CVS) outpatient clinic between March 2015 and June 2015 were included. The burden of INR measurement was assessed in two main categories: social and clinical. Data including educational status, occupational status and accompanying persons, indications for warfarin use, history of warfarin-related complications, expenses made by the patient and the accompanying persons, and the time spent were recorded.Results: A total of 1,259 laboratory entries were found for the overall study population. Of these entries, 99.4% were only for INR measurements. An INR outside the target therapeutic range (TTR) was detected in 53.7% of the patients. Among all patients attending to the CVS outpatient clinic during the study, the sole reason for attendance was the INR measurement in 23%. The rate of complications requiring intervention was 2.1%. The daily clinical cost per patient was $22.14, the social monetary cost was $9.77, and the total cost was $31.91. Conclusion:Conventional INR measurements have a significant social and economic impact on patients and are associated with significantly increased workload and loss of resources from the perspective of the healthcare provider.

The treatment indication affects the time in therapeutic range

“…It was reported that the rate of major bleeding complications was reported between 1.0 and 2.36 in 100 patients using warfarin. [14,15] In the study of Kavasoglu et al, [16] which included 415 patients using warfarin, the rate of major bleeding was reported as 2.6%.…”