title: A multinational investigation of time and traveling costs in attending anticoagulation clinics.
abstract: OBJECTIVE
  Anticoagulation is used in patients with atrial fibrillation to reduce the risk of ischemic stroke. The therapy requires regular monitoring and, frequently, dose adjustment. This study aimed to determine the time and traveling costs that patients incur to themselves and society in attending anticoagulation clinics.
  
  
  METHODS
  A subset of patients from 105 primary and secondary care clinics allocated to the warfarin arm of SPORTIF III (patients from Australia, France, Portugal, Spain, Sweden, and the UK) completed a questionnaire. Patients indicated the type of transport used for clinic visits, and estimated traveling expenses. Patients were also asked to estimate total traveling and clinic attendance time, and to confirm whether they were currently employed and whether they had to give up time from work to attend the clinic. Time cost of companions was also taken into consideration. Cost per visit was calculated (euro, 2003 prices).
  
  
  RESULTS
  Questionnaires for a total of 381 patients were analyzed, with the majority of patients from Sweden (n = 130) and the UK (n = 101). Mean cost to patients varied widely between countries, ranging from euro6.9 (France) to euro20.5 (Portugal) per visit. For most countries, time costs (value of lost working and leisure time) were the main driver of costs. Mean time cost to society ranged from euro5.6 (France) to euro31.7 (Portugal) per visit.
  
  
  CONCLUSIONS
  Patients incur considerable costs when visiting anticoagulation clinics, and these costs vary by country. The results suggest the importance of taking a broad economic perspective when considering the cost-effectiveness of warfarin.
authors.affiliation: Health Economics Facility, Health Services Management Center, University of Birmingham, Birmingham, UK. s.jowett@bham.ac.uk
authors.forename: Sue
authors.initials: S
authors.lastname: Jowett
authors.forename: Stirling
authors.initials: S
authors.lastname: Bryan
authors.forename: Isabelle
authors.initials: I
authors.lastname: Mahé
authors.forename: David
authors.initials: D
authors.lastname: Brieger
authors.forename: Jonas
authors.initials: J
authors.lastname: Carlsson
authors.forename: Bernt
authors.initials: B
authors.lastname: Kartman
authors.forename: Mark
authors.initials: M
authors.lastname: Nevinson
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000191:economics*; D000925:Anticoagulants / Q000191:economics; D001281:Atrial Fibrillation / Q000188:drug therapy; D001315:Australia; D001384:Azetidines / Q000191:economics; D001596:Benzylamines / Q000191:economics; D003625:Data Collection; D016903:Drug Monitoring / Q000191:economics*; D005060:Europe; D005260:Female; D017048:Health Care Costs; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D019934:International Normalized Ratio / Q000191:economics; D008297:Male; D010044:Outpatient Clinics, Hospital; D020521:Stroke / Q000517:prevention & control; D014195:Travel / Q000191:economics*; D014859:Warfarin / Q000191:economics
chemical_list: D000925:Anticoagulants; D001384:Azetidines; D001596:Benzylamines; C426686:ximelagatran; D014859:Warfarin