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Optimal Warfarin Management for Prevention of Thromboembolic Events in Patients with Atrial Fibrillation [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2011 Nov. (CADTH Optimal Use Report, No. 1.2.)


Study, Location,
Study Design,
Time Horizon,
Discounting, Dollar
PopulationComparatorsData Sources
Regier et al.13


Funding: Heart and Stroke Foundation
Markov decision-analytic model (Bayesian)

Incremental costs and health benefits (QALY), ICER
Health care payer perspective

5-year time horizon

3% discount rate

2003 Canadian dollars
Patients receiving chronic warfarin treatmentPatient self-managed care

Physician-managed care
Clinical data, transition probabilities, self-management training costs, resource utilization for a major TEE and utility values from published RCTs and observational studies; frequency of INR testing in self-managed group and some other interventions were assumed. Cost of major hemorrhage from Health Costing in Alberta. Other data from CIHI, Statistics Canada.
Schulman et al.15


Funding: AstraZeneca/ McKesson Specialty
Prospective observational costing study

Direct medical, direct non-medical, direct patient, and productivity loss costs
Health care payer and societal perspective

3-month time horizon

No discounting

2008–2009 Canadian dollars
New and chronically treated patients on warfarin for AF, VTE, aged ≥ 18 years

Excluded patients with history of frequent hospitalization, planned surgery or invasive procedure, geographic inaccessibility, poor compliance
Hospital-based physician-managed anticoagulation

Hospital-based pharmacist-managed care

Community-based family physician-managed care

Community-based pharmacist-managed care
Cost and resource data collected from each site and patient diaries. Unit costs of health care professional consultations, drugs, lab tests, ER visits, patient and caregiver wage, and travel from Ontario Schedule of Benefits, Ontario Drug Benefit, Ontario government; Statistics Canada, Health Costing in Alberta, and CIHI.
Lalonde et al.14


Funding: CIHI, Taro Pharmaceuticals/Optima Pharma
RCT and costing study

Incremental direct medical costs, quality of anticoagulation, adverse events, HRQL
Health care payer perspective

1 year time horizon for costs (6 month RCT)

No discounting

Canadian dollars, year NR
New and chronic warfarin treated patients with stable INR valuesPharmacist managed anticoagulation service

Family physician managed care
Resource utilization and clinical outcome data from administrative and hospital databases. Unit costs from Quebec government and Quebec Association of Hospital Pharmacists.
Bungard et al.16


Funding: Alberta Health and Wellness
Before and after study

Hospitalization costs, adverse events, quality of anticoagulation
Perspective NR (presumed to be health payer)

Time horizon NR

No discounting

Canadian dollars, year NR
Patients referred to pharmacist managed anticoagulation service who have received ≥ 4 months of warfarin therapyPharmacist managed anticoagulation service

Other anticoagulation management
Health resource data and costs from Capital Health Region hospital database and CIHI.

AB = Alberta; AF = atrial fibrillation; BC = British Columbia; CIHI = Canadian Institute of Health Information; ER = emergency room; HRQL = health-related quality of life; ICER = incremental cost effectiveness ratio; INR = International Normalized Ratio; NR = not reported; ON = Ontario; PT = prothrombin time; QALY = quality-adjusted life-year; QC = Quebec; RCT = randomized controlled trial; NB = New Brunswick; TEE = thromboembolic event; VTE = venous thromboembolism.

Copyright © 2011 CADTH.
Cover of Optimal Warfarin Management for Prevention of Thromboembolic Events in Patients with Atrial Fibrillation
Optimal Warfarin Management for Prevention of Thromboembolic Events in Patients with Atrial Fibrillation [Internet].
CADTH Optimal Use Report, No. 1.2.

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