title: Economic evaluation of a randomized controlled trial of pharmacist-supervized patient self-testing of warfarin therapy.
abstract: OBJECTIVE
  The increase in numbers of patients requiring oral anti-coagulation testing in outpatient clinics has focused attention on alternative flexible systems of anti-coagulation management. One option is pharmacist led patient self-testing (PST) of international normalised ratio (INR) levels. PST has demonstrated improvements in anti-coagulation control, but its cost-effectiveness is inconclusive. This study reports the first cost-effectiveness evaluation of a randomized controlled trial of an automated direct-to-patient expert system, enabling remote and effective management of patients on oral anti-coagulation therapy.
  
  
  METHODS
  We conducted an economic evaluation alongside a randomised controlled trial investigating a pharmacist led PST method. The primary outcome was to determine the cost effectiveness of PST in comparison with usual care (management in a hospital based anti-coagulation clinic). Long term anti-coagulation patients were recruited to a 6 month cross over study between PST and routine care in an anti-coagulation clinic. Economic evaluation was from the healthcare payer perspective.
  
  
  CONCLUSIONS
  On a per patient basis over a 6 month period, PST resulted in an incremental cost of €59.08 in comparison with routine care. Patients achieved a significantly higher time in therapeutic range (TTR) during the PST arm in comparison with routine care, (72 ± 19.7% vs. 59 ± 13.5%). Overall cost of managing a patient through pharmacist supervised PST for a 6 month period is €226.45. Additional analysis of strategies from a societal perspective indicated that PST was the dominant strategy.
  
  
  CONCLUSIONS
  Pharmacist led patient self-testing is a viable method of management. It provides significant increases in anti-coagulation control for a minimal increase in cost.
authors.affiliation: Clinical Pharmacy Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Gallagher
authors.forename: S
authors.initials: S
authors.lastname: Mc Carthy
authors.forename: N
authors.initials: N
authors.lastname: Woods
authors.forename: F
authors.initials: F
authors.lastname: Ryan
authors.forename: S
authors.initials: S
authors.lastname: O' Shea
authors.forename: S
authors.initials: S
authors.lastname: Byrne
mesh_terms: D000925:Anticoagulants / Q000097:blood* / Q000191:economics; D003362:Cost-Benefit Analysis / Q000379:methods; D018592:Cross-Over Studies; D017850:Economics, Pharmaceutical / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D010595:Pharmacists / Q000191:economics; D016032:Randomized Controlled Trials as Topic / Q000191:economics*; D012648:Self Care / Q000191:economics* / Q000379:methods*; D014859:Warfarin / Q000097:blood* / Q000191:economics
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: anti-coagulation; clinical pharmacy; cost-effectiveness; international normalised ratio; pharmaceutical care; pharmacoeconomics; pharmacy practice; warfarin