Table 72Self-monitoring or self-management versus usual care – Economic summary of findings

StudyIncremental cost per patient (£)Incremental effects per patient (QALYs)ICER (£/QALY)Uncertainty
Connock 2007401,004(a, b)0.01577(b)63,665(b)Probability cost-effective: 44%
When time horizon considered was 5 years, ICER = £122,365 per QALY.
Jowett 2006112295(c, d)0.009(d)32,778(d)Probability cost-effective: 30%
If patients’ costs are included, ICER = £31437 per QALY gained.
Probability cost-effective: 32%

Using complete case utility values, ICER = £295,000 per QALY gained.
Probability cost-effective: 16%

Patient self-management cost was still significantly higher than usual care when the lifetime of the machine was changed to 5 or 10 years or when the training costs were excluded.
a

2005 GBP. Costs incorporated are: Cost of training for PSM and CoaguCheck machine (for the first year only), GP consultation (x2), internal (x4) and external (x1) quality control, test strip (x26). Cost of acute events (major and minor bleeding, major thrombotic event, fatal stroke). Cost of disability (rehabilitation and long-term care).

b

Time horizon 10 years.

c

2003 GBP. Costs incorporated are: Intervention 1: anticoagulation clinic attendances (staff, equipment, consumables and overheads). Intervention 2: cost of training (2 or 3 sessions), machine (also for patients not continuing with the intervention; the cost was amortised over 3 years), consumables, assessment (15 minute long and carried out by a nurse) and telephone contact for advice specific to PSM. Anticoagulation clinic attendances for patients reverting to usual care.

d

Time horizon 1 year.

2005 GBP. Costs incorporated are: Cost of training for PSM and CoaguCheck machine (for the first year only), GP consultation (x2), internal (x4) and external (x1) quality control, test strip (x26). Cost of acute events (major and minor bleeding, major thrombotic event, fatal stroke). Cost of disability (rehabilitation and long-term care).

Time horizon 10 years.

2003 GBP. Costs incorporated are: Intervention 1: anticoagulation clinic attendances (staff, equipment, consumables and overheads). Intervention 2: cost of training (2 or 3 sessions), machine (also for patients not continuing with the intervention; the cost was amortised over 3 years), consumables, assessment (15 minute long and carried out by a nurse) and telephone contact for advice specific to PSM. Anticoagulation clinic attendances for patients reverting to usual care.

Time horizon 1 year.

From: 12, Self-management and self-monitoring for patients treated with a vitamin K antagonist

Cover of Venous Thromboembolic Diseases
Venous Thromboembolic Diseases: The Management of Venous Thromboembolic Diseases and the Role of Thrombophilia Testing [Internet].
NICE Clinical Guidelines, No. 144.
National Clinical Guideline Centre (UK).
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