Budget Impact of Increasing Market Share of Patient Self-Testing and Patient Self-Management in Anticoagulation.
BACKGROUND
Patient self-testing (PST) and/or patient self-management (PSM) might provide better coagulation care than monitoring at specialized anticoagulation centers. Yet, it remains an underused strategy in the Netherlands.


METHODS
Budget-impact analyses of current and new market-share scenarios of PST and/or PSM compared with monitoring at specialized centers were performed for a national cohort of 260,338 patients requiring long-term anticoagulation testing. A health care payer perspective and 1- to 5-year time horizons were applied. The occurrence of thromboembolic and hemorrhagic complications in the aforementioned patient population was assessed in a Markov model. Dutch-specific costs were applied, next to effectiveness data derived from a meta-analysis on PST and/or PSM. Sensitivity and scenario analyses were performed to assess uncertainty on budget-impact analysis results.


RESULTS
Increasing PST and/or PSM usage in the national cohort from the current 15.4% to 50% resulted in savings ranging from €8 million after the first year to €184 million after 5 years. Further increases in the use of PST and/or PSM produced greater savings. Sensitivity analyses revealed budget-impact model sensitivity to the baseline and relative risks of thromboembolic complications. Unfavorable budget impact was found in scenarios exploring an increase in the use of PST alone as well as an increase in the market share of PST and PSM in patients with atrial fibrillation.


CONCLUSIONS
Overall study findings indicated that PST and PSM are more favorable alternatives to monitoring at specialized centers in patients without atrial fibrillation.
University of Groningen, Groningen, the Netherlands. Electronic address: j.stevanovic@rug.nl.
Jelena
J
Stevanović
University of Groningen, Groningen, the Netherlands.
Maarten J
MJ
Postma
University of Groningen, Groningen, the Netherlands.
Hoa H
HH
Le
D000925:Anticoagulants / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy / Q000191:economics; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D006470:Hemorrhage / Q000191:economics* / Q000517:prevention & control; D006801:Humans; D008390:Markov Chains; D009426:Netherlands / Q000453:epidemiology; D012648:Self Care / Q000379:methods / Q000706:statistics & numerical data; D013923:Thromboembolism / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control
D000925:Anticoagulants
anticoagulation; budget-impact analysis; patient self-management; patient self-testing; point-of-care devices