Warfarin monitoring economic evaluation of point of care self-monitoring compared to clinic settings

Journal of Medical Economics
Joyce A CraigMichelle Jenks

Abstract

To determine the cost-effectiveness of home-based point-of-care self-monitoring compared to clinic-based care for patients managed on long-term warfarin medication. Current evidence is inconsistent; results should reduce uncertainty and inform service delivery. A Markov model compared self-testing and self-management, using point-of-care devices to usual care in patients with atrial fibrillation and mechanical heart valves. The primary clinical end-points were stroke and mortality avoided; costs and utilities were associated with these events. The costs of warfarin monitoring were included in the model. Over 10 years, self-monitoring saved £1187 per person compared to usual care. Patients who self-monitored had notably fewer strokes and deaths. The results were sensitive to life-years gained and cost of the device. If the NHS purchased the device, financial break-even was achieved at the end of the second year; if the patient bought the device the NHS saved money every year. If 10% of the current 950,000 patients switched to point-of-care devices for 10 years, the NHS could save over £112million. Clinical studies had a relatively short duration and only data on composite end-points were reported. With training, self-testing and...Continue Reading

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Citations

Feb 27, 2015·Clinical Chemistry and Laboratory Medicine : CCLM·Céline L van LintChrista M Cobbaert
Mar 15, 2015·Journal of Telemedicine and Telecare·Thomas DavidsonClaes Hallert
May 17, 2018·Culture, Health & Sexuality·Claire Kimberly, Robert McGinley
Jun 19, 2018·Journal of Sex Research·Rhonda N BalzariniJennifer J Harman
Jun 5, 2015·Clinical Chemistry and Laboratory Medicine : CCLM·Ian D WatsonUNKNOWN EFLM Working Group on Patient Focused Laboratory Medicine

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