Anticoagulation clinics and patient self-testing for patients on chronic warfarin therapy: A cost-effectiveness analysis

This study was intended to evaluate the cost-effectiveness of anticoagulati on clinic care and self-testing for the management of patients on chronic w arfarin therapy. Using a 5-year Markov model, we evaluated the health and e conomic outcomes associated with each of three different anticoagulation ma nagement approaches: (1) usual care, (2) anticoagulation clinic testing wit h a capillary monitor, and (3) patient self-testing with a capillary monito r. Data available in the published literature and data from a large health system were used to develop model assumptions. Model results indicate that over a 5-year period, compared with usual care, anticoagulation clinic test ing results in a total of 1.7 fewer thromboembolic events and 2.0 less hemo rrhagic events per 100 patients. Another 4.0 thromboembolic events and 0.8 hemorrhagic events are avoided with patient self-testing compared with anti coagulation clinic testing. In addition to the health advantages of these s trategies, both also have cost advantages. When the costs incurred by provi der organizations and patients are considered, patient self-testing is the most cost-effective alternative, resulting in an overall cost saving.