title: Cost-effectiveness of pharmacist-participated warfarin therapy management in Thailand.
abstract: BACKGROUND
  Although pharmacist-participated warfarin therapy management (PWTM) is well established, the economic evaluation of PWTM is still lacking particularly in Asia-Pacific region. The objective of this study was to estimate the cost-effectiveness of PWTM in Thailand using local data where available.
  
  
  METHODS
  A Markov model was used to compare lifetime costs and quality-adjusted life years (QALYs) accrued to patients receiving warfarin therapy through PWTM or usual care (UC). The model was populated with relevant information from both health care system and societal perspectives. Input data were obtained from literatures and database analyses. Incremental cost-effectiveness ratios (ICERs) were presented as year 2012 values. A base-case analysis was performed for patients at age 45 years old. Sensitivity analyses including one-way and probabilistic sensitivity analyses were constructed to determine the robustness of the findings.
  
  
  RESULTS
  From societal perspective, PWTM and UC results in 39.5 and 38.7 QALY, respectively. Thus, PWTM increase QALY by 0.79, and increase costs by 92,491 THB (3,083 USD) compared with UC (ICER 116,468 THB [3,882.3 USD] per QALY gained). While, from health care system perspective, PWTM also results in 0.79 QALY, and increase costs by 92,788 THB (3,093 USD) compared with UC (ICER 116,842 THB [3,894.7 USD] per QALY gained). Thus, PWTM was cost-effective compared with usual care, assuming willingness-to-pay (WTP) of 150,000 THB/QALY. Results were sensitive to the discount rate and cost of clinic set-up.
  
  
  CONCLUSIONS
  Our finding suggests that PWTM is a cost-effective intervention. Policy-makers may consider our finding as part of information in their decision-making for implementing this strategy into healthcare benefit package. Further updates when additional data available are needed.
authors.affiliation: Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand; Center of Pharmaceutical Outcomes Research (CPOR), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
authors.forename: Surasak
authors.initials: S
authors.lastname: Saokaew
authors.forename: Unchalee
authors.initials: U
authors.lastname: Permsuwan
authors.forename: Nathorn
authors.initials: N
authors.lastname: Chaiyakunapruk
authors.forename: Surakit
authors.initials: S
authors.lastname: Nathisuwan
authors.forename: Apichard
authors.initials: A
authors.lastname: Sukonthasarn
authors.forename: Napawan
authors.initials: N
authors.lastname: Jeanpeerapong
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage* / Q000191:economics*; D003362:Cost-Benefit Analysis; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010595:Pharmacists / Q000191:economics*; D013785:Thailand; D013923:Thromboembolism / Q000097:blood / Q000188:drug therapy* / Q000191:economics*; D014859:Warfarin / Q000008:administration & dosage* / Q000191:economics*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Anticoagulation clinic; Bleeding; Cost-effectiveness; Pharmacist; Thromboembolism; Warfarin