title: Health care expenditures and therapeutic outcomes of a pharmacist-managed anticoagulation service versus usual medical care.
abstract: OBJECTIVE
  To evaluate the differences in health care expenditures and therapeutic outcomes of patients receiving warfarin therapy management by a pharmacist-managed anticoagulation service compared with those receiving warfarin management by usual medical care.
  
  
  METHODS
  Retrospective, matched-cohort study.
  
  
  METHODS
  University of Pittsburgh Medical Center (UPMC) and UPMC Health Plan.
  
  
  METHODS
  Three hundred fifty adults who received warfarin therapy; 175 were managed by the pharmacist-managed anticoagulation service for at least 2 months between October 1, 2007, and September 30, 2008, (case patients) and 175 received usual care (matched comparison group).
  
  
  RESULTS
  Medical claims data compared were direct anticoagulation cost and overall medical care costs, anticoagulation-related adverse events, hospitalizations and emergency department visits, frequency of international normalized ratio (INR) testing, and quantity of warfarin refills. Operational costs of the anticoagulation service were also calculated. The INR values and time within therapeutic range were assessed through anticoagulation service reports and laboratory results. The direct anticoagulation care cost was $35,465 versus $111,586 and the overall medical care cost was $754,191 versus $1,480,661 for the anticoagulation service group versus the usual care group. Accounting for operational and drug expenditure costs, the cost savings was $647,024 for the anticoagulation service group. The anticoagulation service group had significantly fewer anticoagulation-related adverse events (14 vs 41, p<0.0001), hospital admissions (3 vs 14, p<0.00001), and emergency department visits (58 vs 134, p<0.00001). The percentage of INR values in range and the percentage of time the INR values were in range were significantly higher in the anticoagulation service group (67.2% vs 54.6%, p<0.0001, and 73.7% vs 61.3%, p<0.0001, respectively). Compared with the usual care group, the anticoagulation service group had significantly more INR tests performed but demonstrated no significant difference in the quantity of drug refills.
  
  
  CONCLUSIONS
  After accounting for operational costs, pharmacist-managed anticoagulation leads to reduced health care expenditure while improving therapeutic outcomes compared with usual medical care.
authors.affiliation: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. halldl@upmc.edu
authors.forename: Deanne
authors.initials: D
authors.lastname: Hall
authors.forename: Julianne
authors.initials: J
authors.lastname: Buchanan
authors.forename: Bethany
authors.initials: B
authors.lastname: Helms
authors.forename: Matthew
authors.initials: M
authors.lastname: Eberts
authors.forename: Scott
authors.initials: S
authors.lastname: Mark
authors.forename: Chronis
authors.initials: C
authors.lastname: Manolis
authors.forename: Pamela
authors.initials: P
authors.lastname: Peele
authors.forename: Anne
authors.initials: A
authors.lastname: Docimo
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000458:organization & administration*; D000925:Anticoagulants / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D015331:Cohort Studies; D017046:Cost Savings; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D019934:International Normalized Ratio / Q000379:methods; D008297:Male; D008875:Middle Aged; D010593:Pharmaceutical Services / Q000191:economics / Q000458:organization & administration; D010595:Pharmacists / Q000191:economics / Q000458:organization & administration*; D024382:Professional Role; D012189:Retrospective Studies; D016896:Treatment Outcome; D014859:Warfarin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin