Cost-minimisation analysis of oral anticoagulant therapy monitoring methods: the case for prothrombin time self-monitoring.
BACKGROUND
Anticoagulant therapy is usually chronic and is indicated for the treatment of several medical conditions. The most common of these include patients with mechanical heart valves and those suffering from atrial fibrillation.


METHODS
This study compares two methods of oral anticoagulant therapy (OAT) monitoring: traditional prothrombin time measurement and self-measuring or self-regulation by the patient. As numerous published studies indicate that the two methods are equally effective (while underlining significant deviations in the frequency of complications), a cost-minimisation analysis was applied. The methodology was based on the consensus of experts from different geographical regions and health service sets. All costs and benefits attributable to patient treatment were examined and analysed from the perspective of the Greek National Health System (NHS).


RESULTS
From the analysis it was estimated that the savings from the use of self-monitoring could reach Euro 6,132,750 at market prices for a five-year period. The potential economic benefit from the expansion of self-monitoring to all eligible patients was equal to approximately 10% of the total treatment cost of the entire patient population under OAT in Greece. In addition, the social benefits resulting from higher prevention rates of possible complications, as well as the improvement in patients' quality of life should not be underestimated. The total reduction in private expenditure deriving from the expansion of self-monitoring was estimated at Euro 3,096,000, while savings for the NHS were estimated at Euro 2,473,317 over a five-year period.


CONCLUSIONS
The benefit to the healthcare system from the use of self-monitoring is significant, and the further use of this technology could contribute to the rational allocation of healthcare resources.
Geitona
Mary
M
Department of Economics, University of Thessaly, Volos, Greece.
Hollandezos
Mark
M
Souliotis
Kyriakos
K
Athanasakis
Kostas
K
Kyriopoulos
John
J
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000191:economics*; D017046:Cost Savings; D006115:Greece; D006801:Humans; D008991:Monitoring, Physiologic / Q000191:economics* / Q000379:methods; D011517:Prothrombin Time; D012648:Self Care / Q000592:standards; D013222:State Medicine / Q000191:economics
D000925:Anticoagulants