The cost-effectiveness of different management strategies for patients on chronic warfarin therapy

OBJECTIVE:To examine the cost-effectiveness of moving from usual care to mo re organized management strategies for patients on chronic warfarin therapy . DESIGN:Using information available in the scientific literature, supplement ed with data from a large health system and, when necessary, expert opinion , we constructed a 5-year Markov model to evaluate the health and economic outcomes associated with each of three different anticoagulation management approaches: usual care, anticoagulation clinic testing with a capillary mo nitor, and patient self-testing with a capillary monitor. PATIENTS:Three hypothetical cohorts of patients beginning long-term warfari n therapy were used to generate model results. MAIN RESULTS:Model results indicated that moving from usual care to anticoa gulation clinic testing would result in a total of 1.7 thromboembolic event s and 2.0 hemorrhagic events avoided per 100 patients over 5 years. Another 4.0 thromboembolic events and 0.8 hemorrhagic events would be avoided by m oving to patient self-testing. When direct medical care costs and those inc urred by patients and their caregiver, in receiving care were considered, p atient self-testing was the most cost-effective alternative, resulting in a n overall cost saving. CONCLUSIONS:Results illustrate the potential health and economic benefits o f organized care management approaches and capillary monitors in the manage ment of patients receiving warfarin therapy.