The Cost-Effectiveness of Different Management Strategies for Patients on Chronic Warfarin Therapy


  • Presented at the Society of General Internal Medicine 21st annual meeting, Chicago, Il, April 23–25, 1998; Building Bridges IV: Improving the Public's Health Through Research Partnerships, Oakland, Calif, May 7–9, 1998; Association for Health Services Research, Washington, DC, June 21–23, 1998; European Cardiology Conference, Vienna, Austria, August 24–28, 1998; and Anticoagulation Forum's 5th annual conference, Vancouver, BC, May 13–15, 1999.

Address correspondence and reprint requests to Dr. Elston Lafata: Henry Ford Health System, Center for Health Services Research, 1 Ford Place–3A, Detroit, MI 48202 (e-mail: JLAFATA1@HFHS.ORG).


OBJECTIVE: To examine the cost-effectiveness of moving from usual care to more organized management strategies for patients on chronic warfarin therapy.

DESIGN: Using information available in the scientific literature, supplemented with data from a large health system and, when necessary, expert opinion, we constructed a 5-year Markov model to evaluate the health and economic outcomes associated with each of three different anticoagulation management approaches: usual care, anticoagulation clinic testing with a capillary monitor, and patient self-testing with a capillary monitor.

PATIENTS: Three hypothetical cohorts of patients beginning long-term warfarin therapy were used to generate model results.

MAIN RESULTS: Model results indicated that moving from usual care to anticoagulation clinic testing would result in a total of 1.7 thromboembolic events and 2.0 hemorrhagic events avoided per 100 patients over 5 years. Another 4.0 thromboembolic events and 0.8 hemorrhagic events would be avoided by moving to patient self-testing. When direct medical care costs and those incurred by patients and their caregivers in receiving care were considered, patient self-testing was the most cost-effective alternative, resulting in an overall cost saving.

CONCLUSIONS: Results illustrate the potential health and economic benefits of organized care management approaches and capillary monitors in the management of patients receiving warfarin therapy.