Costs of outpatient anticoagulant treatment in patients with cerebral and peripheral arterial occlusive disease

Background and objective: Knowledge of the costs of oral anticoagulant (AC) treatment may be relevant for resource allocation. Also, the incremental c osts may be compared with other treatments for health care policy decisions . In this report, we have assessed actual costs of anticoagulant therapy in anticoagulation clinics (AC-clinic) in three different settings in the Net herlands. Methods: Costs of anticoagulant drug supply and costs as a result of INR-adjustment procedures were estimated. We compared the total costs o f treatment in patients treated after minor cerebral ischaemia in the Strok e Prevention in Reversible Ischemia Trial (SPIRIT) and in patients treated because of peripheral arterial occlusive disease in the Dutch Bypass Oral a nticoagulants or Aspirin Trial (BOA). Results: Costs of monitoring ranged b etween Euro 6.44 and Euro 9.87 per visit for monitoring at the AC-clinic an d at home, respectively. The annual costs of administering anticoagulant dr ugs ranged between Euro 83 (phenprocoumon) and 107 (acenocoumarol), Variati on in the overall actual annual costs of AC treatment was caused by the num ber of monitoring visits, the distribution of home and clinic visits and, t o a lesser extent, the medication used. Annual costs of AC therapy for pati ents in SPIRIT was Euro 239 and for patients in BOA Euro 312. Overall costs of anticoagulant therapy were about 3 to 4-fold higher than standard treat ment with aspirin. Conclusions: Although the actual costs of anticoagulant therapy may be substantially higher than that of other antithrombotic thera pies, its cost-effectiveness depends highly on efficacy.