Publication: Cost-effectiveness analysis of patient self-testing therapy of oral anticoagulation
Issued Date
2018-02-01
Resource Type
ISSN
1573742X
09295305
09295305
Other identifier(s)
2-s2.0-85035125846
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Mahidol University
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SCOPUS
Bibliographic Citation
Journal of Thrombosis and Thrombolysis. Vol.45, No.2 (2018), 281-290
Suggested Citation
Sutat Kantito, Surasak Saokaew, Sukit Yamwong, Prin Vathesatogkit, Wisuit Katekao, Piyamitr Sritara, Nathorn Chaiyakunapruk Cost-effectiveness analysis of patient self-testing therapy of oral anticoagulation. Journal of Thrombosis and Thrombolysis. Vol.45, No.2 (2018), 281-290. doi:10.1007/s11239-017-1588-8 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/46983
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Title
Cost-effectiveness analysis of patient self-testing therapy of oral anticoagulation
Abstract
© 2017, Springer Science+Business Media, LLC, part of Springer Nature. Patient Self-testing (PST) could be an option for present anticoagulation therapy monitoring, but current evidence on its cost-effectiveness is limited. This study aims to estimate the cost-effectiveness of PST to other different care approaches for anticoagulation therapy in Thailand, a low-to-middle income country (LMIC). A Markov model was used to compare lifetime costs and quality-adjusted life years (QALYs) accrued to patients receiving warfarin through PST or either anticoagulation clinic (AC) or usual care (UC). The model was populated with relevant information from literature, network meta-analysis, and database analyses. Incremental cost-effectiveness ratios (ICERs) were presented as the year 2015 values. A base-case analysis was performed for patients at age 45-year-old. Sensitivity analyses including one-way and probabilistic sensitivity analyses (PSA) were constructed to determine the robustness of the findings. From societal perspective, PST increased QALY by 0.87 and costs by 112,461 THB compared with UC. Compared with AC, PST increased QALY by 0.161 and costs by 21,019 THB. The ICER with PST was 128,697 (3625 USD) and 130,493 THB (3676 USD) per QALY gained compared with UC and AC, respectively. The probability of PST being cost-effective is 74.1% and 51.9%, compared to UC and AC, respectively, in Thai context. Results were sensitive to the efficacy of PST, age and frequency of hospital visit or self-testing. This analysis suggested that PST is highly cost-effective compared with usual care and less cost-effective against anticoagulation clinic. Patient self-testing strategy appears to be economically valuable to include into healthcare system within the LMIC context.