Journal of General Internal Medicine

, Volume 15, Issue 1, pp 31–37

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

Authors

    • Henry Ford Health SystemCenter for Health Services Research
  • Susan A. Martin
    • Henry Ford Health SystemCenter for Health Services Research
  • Scott Kaatz
    • Henry Ford Health SystemCenter for Health Services Research
  • Richard E. Ward
    • Henry Ford Health SystemCenter for Health Services Research
Original Articles

DOI: 10.1046/j.1525-1497.2000.01239.x

Cite this article as:
Lafata, J.E., Martin, S.A., Kaatz, S. et al. J GEN INTERN MED (2000) 15: 31. doi:10.1046/j.1525-1497.2000.01239.x

Abstract

OBJECTIVE: To examine the cost-effectiveness of moving from usual care to more organized management strategies for patients on chronic warfarin therapy.

DESIGN: Using information available in the scientific literature, supplemented 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 monitor, and patient self-testing with a capillary monitor.

PATIENTS: Three hypothetical cohorts of patients beginning long-term warfarin therapy were used to generate model results.

MAIN RESULTS: Model results indicated that moving from usual care to anticoagulation clinic testing would result in a total of 1.7 thromboembolic events 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 moving to patient self-testing. When direct medical care costs and those incurred by patients and their caregivers in receiving care were considered, patient self-testing was the most cost-effective alternative, resulting in an overall cost saving.

CONCLUSIONS: Results illustrate the potential health and economic benefits of organized care management approaches and capillary monitors in the management of patients receiving warfarin therapy.

Key Words

anticoagulation management cost-effectiveness analysis decision analytic model warfarin

Copyright information

© Society of General Internal Medicine 2000