A multinational investigation of time and traveling costs in attending anticoagulation clinics.
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.
Jowett
Sue
S
Health Economics Facility, Health Services Management Center, University of Birmingham, Birmingham, UK. s.jowett@bham.ac.uk
Bryan
Stirling
S
Mahé
Isabelle
I
Brieger
David
D
Carlsson
Jonas
J
Kartman
Bernt
B
Nevinson
Mark
M
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
D000925:Anticoagulants; D001384:Azetidines; D001596:Benzylamines; C426686:ximelagatran; D014859:Warfarin