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.

Limitations:

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.

Keywords::

• Point-of-care devices
• Warfarin
• Self-monitoring
• Cost-saving

Transparency

Declaration of funding

Funding was provided by Roche Diagnostics Limited. The sponsor has commented on a draft manuscript, but the corresponding author had final decision on content and the decision to submit for publication.

Declaration of financial/other relationships

No authors had any other financial or other relationships with the sponsor. No assistance in the preparation of this article is to be declared.