title: [Incorrect dosage of anticoagulant therapy is expensive. Could self-monitoring improve the situation?].
abstract: In Sweden, the use of anticoagulants has increased by 30 per cent during the 1990s, approximately 45,000 (5.3/1000) of the population being on continuous treatment in 1995. At present, the effect of anticoagulant treatment is monitored at hospitals and out-patient clinics, and by general practitioners. In very few cases is it monitored by patients them-selves. In the article are presented the results of an analysis of published figures, performed to elicit the frequency of anticoagulant controls, that of serious haemorrhages occurring in conjunction with therapeutic anticoagulant levels above the recommended INR (international normalised ratio) ranges, and that of thrombo-embolic events occurring in conjunction with levels below the INR ranges, and the corresponding estimated costs of insufficient control. Mean overall exposure to increased risk of haemorrhage was approximately 2,300 patient-years (range, 670-4,050), and that to increased risk of recurrent thrombosis or embolism 4,300 patient-years (range, 1,013-7,650). The mean estimated cost of haemorrhagic complications was SEK 34 m (range, 11.6-54.7), and that of thrombo-embolic complications approximately SEK 49 m (range, 22.6-73.9) (1 GBP = 13.5 SEK, 1 USD = 7.4 SEK). Part of these costs could have been avoided by reducing the duration of insufficient control. Future research will show whether self-monitoring would achieve this.
authors.affiliation: Uppsala universitet, Akademiska sjukhuset.
authors.forename: A
authors.initials: A
authors.lastname: Terént
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D016903:Drug Monitoring; D004363:Drug Utilization; D006470:Hemorrhage / Q000139:chemically induced / Q000191:economics; D006801:Humans; D012651:Self Medication; D013548:Sweden; D013927:Thrombosis / Q000188:drug therapy / Q000517:prevention & control
chemical_list: D000925:Anticoagulants
vernacular_title: Dyrt med felinställd antikoagulantiaterapi. Kan egenkontroll förbättra situationen?