title: Warfarin monitoring economic evaluation of point of care self-monitoring compared to clinic settings.
abstract: OBJECTIVE
  To determine the cost-effectiveness of home-based point-of-care self-monitoring compared to clinic-based care for patients managed on long-term warfarin medication. Current evidence is inconsistent; results should reduce uncertainty and inform service delivery.
  
  
  METHODS
  A Markov model compared self-testing and self-management, using point-of-care devices to usual care in patients with atrial fibrillation and mechanical heart valves. The primary clinical end-points were stroke and mortality avoided; costs and utilities were associated with these events. The costs of warfarin monitoring were included in the model.
  
  
  RESULTS
  Over 10 years, self-monitoring saved £1187 per person compared to usual care. Patients who self-monitored had notably fewer strokes and deaths. The results were sensitive to life-years gained and cost of the device. If the NHS purchased the device, financial break-even was achieved at the end of the second year; if the patient bought the device the NHS saved money every year. If 10% of the current 950,000 patients switched to point-of-care devices for 10 years, the NHS could save over £112million.
  
  
  CONCLUSIONS
  Clinical studies had a relatively short duration and only data on composite end-points were reported.
  
  
  CONCLUSIONS
  With training, self-testing and self-management are safe, reliable, and cost-effective for a sizable proportion of patients receiving long-term warfarin. Compared to clinic-based services, self-monitoring offers the NHS the potential to make cost savings and release bed-days by reducing the number of strokes experienced by these high-risk patients.
authors.affiliation: York Health Economics Consortium, University of York , York , UK.
authors.forename: Joyce A
authors.initials: JA
authors.lastname: Craig
authors.forename: Stephen
authors.initials: S
authors.lastname: Chaplin
authors.forename: Michelle
authors.initials: M
authors.lastname: Jenks
mesh_terms: D000925:Anticoagulants / Q000097:blood* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy; D003362:Cost-Benefit Analysis; D006350:Heart Valve Prosthesis; D006801:Humans; D008390:Markov Chains; D011788:Quality of Life; D012648:Self Care / Q000191:economics* / Q000379:methods*; D013222:State Medicine / Q000706:statistics & numerical data; D006113:United Kingdom; D014859:Warfarin / Q000097:blood* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin