PCV44 Cost-Utility Associated with Different Monitoring Strategies Among Patients Receiving Long-Term Oral Anticoagulation Therapy in Austria

Abstract

OBJECTIVES: To ascertain the cost-utility of patient self-management (PSM) compared to standard monitoring among long-term oral anticoagulation therapy patients in Austria. METHODS: A Markov model was used to combine international effectiveness data and local cost and mortality data in a life-long simulation (closed cohort with a mean baseline age of 67 years). Costs were calculated using information on healthcare contacts from healthcare professionals and associated tariffs. Costs for standard monitoring were based on monthly visits to primary/outpatient settings and determination of PTZ levels. PSM costs included costs of the handheld device, materials, training and regular healthcare check-ups. Costs associated with complications (thrombotic and haemorrhagic events) in primary-care, acute care and rehabilitation settings were also considered, since complications occur at different rates between monitoring strategies. Sensitivity analyses were performed. RESULTS: PSM was associated with 15.9 life years or 10.7 QALYs compared to 14.6 life years or 9.4 QALYs with standard monitoring. Costs per patient for the entire period were 7,873 for PSM, 8,170 for monitoring by GPs, 8,354 for monitoring by community-based consultants and 8,810 for monitoring at a hospital out-patient clinic. PSM was the dominant strategy for both the cost per lifeyear gained and cost per QALY analysis. Although PSM led to higher initial costs (between 908 and 916 per patient in the first year), follow-up costs were lower (between 228 and 235 per patient per year thereafter) due to lower frequency of health care visits. Standard monitoring was associated with monitoring costs of between 273 and 391 per patient per year. CONCLUSIONS: Encouraging suitable patients to self-manage leads to better health outcomes and lower costs. In Austria, initial costs are compensated by lower complication rates and associated costs and lower monitoring expenses. Cost-savings to the health sector could be accrued as soon as 3 years after patients switch strategies.