PCV128 A Real World Evaluation to Describe the Characteristics, Outcomes and Resource Use Associated with Patients Being Managed by a Secondary Care Based Anticoagulation Service

Abstract

with relevant follow up for positive tests. Prior to the test, attenders were given a questionnaire about their doubt and arguments in relation to the participation decision, including different willingness-to-pay (WTP) questions. Non-attenders were mailed a similar questionnaire. RESULTS: 70% responded to the questionnaire, which lead to a study sample of 1,053 attenders and 435 non-attenders. Among attenders, 5% had doubt about participation and the most frequent argument was that they did not want to know about the test result. Among non-attenders, 46% would reconsider attendance after further information, the main argument for doubt being the same as for attenders. Further arguments were selfperceived low risk and the trouble and costs associated with attending. Attenders valued the programme significantly higher than non-attenders but this was sensitive to exclusion of bidders who did not pass a simple test for internal consistency of the reported WTP. Doubt about participation was associated with significantly lower WTP among attenders whereas the opposite was the case for non-attenders. Amongst those in doubt, the WTP was the same for attenders and non-attenders. CONCLUSIONS: Up to half of the non-attenders appeared to have doubt about their decision, which presents a potential for increasing the participation rate. Nonattenders in doubt about their participation decision value the programme at a similar level as attenders in doubt, suggesting that non-attenders in doubt do not differ significantly in their base-line valuations from those of the individuals in doubt who choose to attend.

Cost-effectiveness analysis of treatment of venous thromboembolism with rivaroxaban compared with combined low molecular weight heparin/vitamin K antagonist

“…A particularly critical area of uncertainty identified a priori during model development was INR monitoring frequency. Owing to wide variation in both UK clinical practice and published estimates [ 15 , 16 , 18 , 56 ], a service evaluation and national survey were conducted to obtain the models of anticoagulation, quantify its distribution and collect resource-use data to ensure that the analysis represented clinical practice [ 51 ]. Local care pathways will determine whether such savings can be realized consistently.…”

“…Because warfarin is the most commonly used VKA for VTE treatment in the UK [ 12 ], and was also the most frequently used VKA in the EINSTEIN DVT and EINSTEIN PE studies [ 25 , 26 ], it was selected for the model. To facilitate understanding of the contemporary provision of anticoagulation care, a survey of models of care was conducted (Bayer, data on file) [ 51 ]. Results suggested that, instead of traditional secondary care (consultant-led services), primary care is now the most common setting for provision of these services.…”

“…Therefore, based on the results of this survey, the primary care-setting cost was applied in 66.5% of cases and the secondary care-setting cost in the remaining 33.5% of cases; transport services were required by 8.6% of patients managed in secondary care. It was assumed that patients receiving a VKA would require a mean of nine coagulation monitoring visits in the first 3 months and five visits per quarter thereafter (Table 6 ) [ 15 , 18 , 25 , 51 ].…”

“…LMWH) required by a PE patient 9.7 7 13 Dirichlet Mean duration from EINSTEIN PE [ 26 ] Proportion of patients who self-inject LMWH (%) 92 64.40 100 Beta The point estimate is taken from the assumptions in NICE CG92 [ 56 ]. The sensitivity range is an assumption Proportion of remaining patients who require nurse assistance at home (%) 80 60 100% Beta These values are assumptions based on inputs determined for the NICE CG92 model INR monitoring while on LMWH/VKA Visits in first 3 months 9 5 15 Gamma EINSTEIN DVT [ 25 , 51 ] SIGN guidelines [ 15 , 51 ] Visits each 3 months thereafter 5 2.5 10 Gamma BNF [ 18 , 51 ] Recurrent VTE: proportion treated as outpatients rather than inpatients Recurrent DVT patients (%) 69 50 100 Beta SIGN guidelines [ 15 ] Incident PE patients (%) 17 0 30 Beta Survey data Other Proportion of patients requiring NHS-funded transportation (%) 8.55 6 11 Beta Survey data Proportion of CTEPH patients who require PEA (%) 68.40 64.20 72.60 Beta 321 of 469 patients from Condliffe 2008 [ 43 ] Length of admission post DVT, days …”

Enabling better management of patients: discrete event simulation combined with the STAR approach

“…greater than 2), a negative D-dimer test result and a positive ultrasound result then treatment commences (7.728% of all cases -see Outcome 2 from Table 2). Note that there are many combinations and the percentages are calculated using the values shown in Typically, 22%, 63% and 15% of provoked patients on Warfarin visit anticoagulation clinics (also known as INR clinics) on an average of 9, 14 and 24 times over 3, 6 and 12 months, respectively (Winter, Keeling , Sharpen, Cohen, & Vallance, 2005) (Rose, James, Chapman, & Marshall, 2011). In the case of Unprovoked patients on Warfarin, 6%, 63% and 31% visit INR clinics on average of 9, 14 and 24 times over 3, 6 and 12 months, respectively.…”