title: Organization and estimated patient-borne costs of oral anticoagulation therapy in Italy: results from a survey.
abstract: BACKGROUND
  The management of the large patient population in Italy receiving long-term oral anticoagulation therapy (OAT) poses organizational challenges that are traditionally approached with a centralized procedure, relying on hospital-based clinics and/or GPs. However, the availability of near-patient testing devices for the monitoring of OAT effectiveness (international normalized ratio measurement) allows for alternative or complementary management models, in which adequately trained patients perform the test themselves and possibly make decisions about dosing adjustments (patient self-monitoring). Patient self-monitoring has been proven to be effective and safe, and is economically attractive. However, in order to assess its potential economic impact in Italy, there is a need for data on current treatment patterns and relative costs, which are currently not available.
  
  
  OBJECTIVE
  To establish prevalent management patterns and costs incurred by Italian OAT patients.
  
  
  METHODS
  An ad hoc questionnaire was developed and administered to OAT patients with the support of the main Italian OAT patients association. Returned questionnaires were checked for consistency and valid data were summarized. Resources used were costed according to published prices.
  
  
  RESULTS
  A total of 4722 valid questionnaires were returned from all over Italy. The prevalent OAT management model in this sample relied on hospital-based anticoagulation clinics. Significant earning losses, transportation costs and other out-of-pocket expenses were incurred by patients, with an estimated mean overall monthly cost of approximately €30 (year 2008 value). There was a wide distribution of costs in this population, depending mainly on monitoring frequency, home-to-clinic distance and employment status.
  
  
  CONCLUSIONS
  This study contributes to clarifying the organizational models of the Italian OAT population and delivers data on treatment patterns and costs that may be used when planning and evaluating alternative management options.
authors.affiliation: AdRes Health Economics & Outcomes Research, Turin, Italy. l.pradelli@dreshe.com
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Pradelli
authors.forename: Sergio
authors.initials: S
authors.lastname: Iannazzo
authors.forename: Orietta
authors.initials: O
authors.lastname: Zaniolo
authors.forename: Paola
authors.initials: P
authors.lastname: Botrugno
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000191:economics*; D016527:Drug Costs / Q000706:statistics & numerical data*; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D007558:Italy; D008297:Male; D011795:Surveys and Questionnaires
chemical_list: D000925:Anticoagulants