title: Patient self-management of anticoagulation therapy: a trial-based cost-effectiveness analysis.
abstract: Demand for anticoagulation management is increasing due to an expansion of clinical indications for therapy. One possible model of care to meet demand is patient self-management (PSM), beneficial to patients who need control over their condition. This study aimed to determine the cost and cost-effectiveness of PSM of anticoagulation compared with routine clinic-based care for patients receiving long-term anticoagulation. A cost-utility analysis was conducted alongside a randomised controlled trial; 617 patients were recruited and followed up for 12 months. There was no significant difference in mean quality-adjusted life years (QALYs) between groups - after adjusting for baseline, the mean difference in QALYs was 0.009 (95% CI, -0.012 to 0.030). Overall mean healthcare costs in the PSM arm were significantly higher at pounds sterling 417 (CI pounds sterling 394- pounds sterling 442) compared with pounds sterling 122 (CI pounds sterling 103- pounds sterling 144) in the control arm. Therefore, using a formal cost-effectiveness analysis, PSM of anticoagulation does not appear to be cost-effective. However, PSM may have other benefits in relieving pressure on traditional clinic-based care, and the cost-effectiveness of this model of care for some subgroups of anticoagulation patients needs to be explored further.
authors.affiliation: Health Economics Facility, Health Services Management Centre, University of Birmingham, Birmingham, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Jowett
authors.forename: Stirling
authors.initials: S
authors.lastname: Bryan
authors.forename: Ellen
authors.initials: E
authors.lastname: Murray
authors.forename: Deborah
authors.initials: D
authors.lastname: McCahon
authors.forename: James
authors.initials: J
authors.lastname: Raftery
authors.forename: F D Richard
authors.initials: FD
authors.lastname: Hobbs
authors.forename: David
authors.initials: D
authors.lastname: Fitzmaurice
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000191:economics; D012646:Self Administration / Q000191:economics* / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants