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J Med Econ. 2014 Mar;17(3):184-90. doi: 10.3111/13696998.2013.877468. Epub 2014 Jan 24.

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

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  • 1York Health Economics Consortium, University of York , York , UK.

Abstract

OBJECTIVE:

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.

METHODS:

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.

RESULTS:

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.

LIMITATIONS:

Clinical studies had a relatively short duration and only data on composite end-points were reported.

CONCLUSIONS:

With training, self-testing and self-management are safe, reliable, and cost-effective for a sizable proportion of patients receiving long-term warfarin. Compared to clinic-based services, self-monitoring offers the NHS the potential to make cost savings and release bed-days by reducing the number of strokes experienced by these high-risk patients.

PMID:
24351064
[PubMed - indexed for MEDLINE]
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