Anticoagulation Patient Self-monitoring in the United States

Considerations for Clinical Practice Adoption

Edith A. Nutescu, Pharm.D.; Sacheeta Bathija, B.Pharm.; Lisa K. Sharp, Ph.D.; Ben S. Gerber, M.D., M.P.H.; Glen T. Schumock, Pharm.D., M.B.A.; Marian L. Fitzgibbon, Ph.D.

Disclosures

Pharmacotherapy. 2011;31(12):1161-1174. 

In This Article

Economic Considerations

Although the economic benefits of PST and PSM are not entirely clear and more data are needed to clarify potential economic advantages, one early study suggested that PST and PSM may be cost-effective in those patients receiving longterm anticoagulation.[77] Another study estimated that if 50% of those receiving warfarin had received optimal anticoagulation, 9852 emboli would be prevented and $1.3 billion would be saved.[78] Other studies, however, suggested that PST or PSM may not be cost-effective mainly due to the high costs of the monitoring devices, test strips, and training.[34,79] In the THINRS study,[67] the mean cost of patient self-testing during the first 2 years of follow-up was higher than that of anticoagulation clinic testing by $1249 (95% CI –$1205–3703, p=0.32), and one must question whether these costs are worth the benefits of PST. Although a reduction in the primary end point was not noted in the PST group, a benefit was observed with regard to quality of life (difference in cumulative gain at 2 yrs on the Health Utilities Index Mark 3 of 0.155, 95% CI 0.111–0.198, p<0.001). This suggests an incremental cost-effectiveness ratio of about $8100/quality-adjusted life-year gained. This is at a value that is lower compared with other interventions considered to have an acceptable trade-off of health for cost.[80] Ultimately, wide-scale adoption of self-monitoring will depend on the overall well-documented economic benefit.

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