Patient self-management of anticoagulation therapy: a trial-based cost-effectiveness analysis

Sue Jowett, Stirling Bryan, Ellen Murray, Deborah McCahon, James Raftery, F D Richard Hobbs, David Fitzmaurice

Research output: Contribution to journalArticle (Academic Journal)peer-review

41 Citations (Scopus)

Abstract

Demand for anticoagulation management is increasing due to an expansion of clinical indications for therapy. One possible model of care to meet demand is patient self-management (PSM), beneficial to patients who need control over their condition. This study aimed to determine the cost and cost-effectiveness of PSM of anticoagulation compared with routine clinic-based care for patients receiving long-term anticoagulation. A cost-utility analysis was conducted alongside a randomised controlled trial; 617 patients were recruited and followed up for 12 months. There was no significant difference in mean quality-adjusted life years (QALYs) between groups - after adjusting for baseline, the mean difference in QALYs was 0.009 (95% CI, -0.012 to 0.030). Overall mean healthcare costs in the PSM arm were significantly higher at pounds sterling 417 (CI pounds sterling 394- pounds sterling 442) compared with pounds sterling 122 (CI pounds sterling 103- pounds sterling 144) in the control arm. Therefore, using a formal cost-effectiveness analysis, PSM of anticoagulation does not appear to be cost-effective. However, PSM may have other benefits in relieving pressure on traditional clinic-based care, and the cost-effectiveness of this model of care for some subgroups of anticoagulation patients needs to be explored further.

Original languageEnglish
Pages (from-to)632-9
Number of pages8
JournalBritish Journal of Haematology
Volume134
Issue number6
DOIs
Publication statusPublished - Sep 2006

Keywords

  • Aged
  • Anticoagulants
  • Cost-Benefit Analysis
  • Drug Costs
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Education as Topic
  • Self Administration
  • Treatment Outcome
  • Journal Article
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

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