title: The economic costs of routine INR monitoring in infants and children--examining point-of-care devices used within the home setting compared to traditional anticoagulation clinic monitoring.
abstract: BACKGROUND
  The use of point-of-care (POC) devices within the home for routine INR monitoring has demonstrated reliability, safety and effectiveness in the management of infants and children requiring long-term warfarin therapy. However, a comprehensive cost-analysis of using this method of management, compared to attending anticoagulation clinics has not been reported. The aim of this study was to compare the estimated societal costs of attending anticoagulation clinics for routine INR monitoring to using a POC test in the home.
  
  
  METHODS
  This study used a comparative before-and-after design that included 60 infants and children managed via the Haematology department at a tertiary paediatric centre. Each participant was exposed to both modes of management at various times for a period of ≥3 months. A questionnaire, consisting of 25 questions was sent to families to complete and return. Data collected included: the frequency of monitoring, mode of travel to and from clinics, total time consumed, and primary carer's income level.
  
  
  RESULTS
  The home monitoring cohort saved a total of 1 hour 19 minutes per INR test compared to attending anticoagulation clinics and had a cost saving to society of $66.83 (AUD) per INR test compared to traditional care; incorporating health sector costs, travel expenses and lost time.
  
  
  CONCLUSIONS
  The traditional model of care requires a considerable investment of time per test from both child and carer. Home INR monitoring in infants and children provides greater societal economic benefits compared to traditional models.
authors.affiliation: Clinical Haematology, The Royal Children's Hospital, Melbourne, Australia. james.gaw@me.com
authors.forename: James R
authors.initials: JR
authors.lastname: Gaw
authors.forename: Steven
authors.initials: S
authors.lastname: Crowley
authors.forename: Paul
authors.initials: P
authors.lastname: Monagle
authors.forename: Sophie
authors.initials: S
authors.lastname: Jones
authors.forename: Fiona
authors.initials: F
authors.lastname: Newall
mesh_terms: D000293:Adolescent; D000554:Ambulatory Care Facilities / Q000191:economics; D000925:Anticoagulants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D016903:Drug Monitoring / Q000191:economics* / Q000295:instrumentation; D005260:Female; D006801:Humans; D007223:Infant; D019934:International Normalized Ratio / Q000191:economics* / Q000295:instrumentation; D008297:Male; D019095:Point-of-Care Systems / Q000191:economics*; D012648:Self Care / Q000191:economics* / Q000295:instrumentation; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: ACC; AUD; Australian dollars; Children; Cost-effectiveness; HINRMP; Health economics; INR; International Normalised Ratio; International Normalised Ratio (INR); NSW; New South Wales; POC; Point-of-care (POC); RCH; Royal Children’s Hospital; Warfarin; anticoagulation clinic (outpatient); home INR monitoring program; point-of-care