Budget Impact of Increasing Market Share of Patient Self-Testing and Patient Self-Management in Anticoagulation

Jelena Stevanović, Maarten J. Postma, Hoa H. Le

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Abstract

Background: Patient self-testing (PST) and/or patient self-management (PSM) might provide better coagulation care than monitoring at specialized anticoagulation centers. Yet, it remains an underused strategy in the Netherlands. Methods: Budget-impact analyses of current and new market-share scenarios of PST and/or PSM compared with monitoring at specialized centers were performed for a national cohort of 260,338 patients requiring long-term anticoagulation testing. A health care payer perspective and 1- to 5-year time horizons were applied. The occurrence of thromboembolic and hemorrhagic complications in the aforementioned patient population was assessed in a Markov model. Dutch-specific costs were applied, next to effectiveness data derived from a meta-analysis on PST and/or PSM. Sensitivity and scenario analyses were performed to assess uncertainty on budget-impact analysis results. Results: Increasing PST and/or PSM usage in the national cohort from the current 15.4% to 50% resulted in savings ranging from €8 million after the first year to €184 million after 5 years. Further increases in the use of PST and/or PSM produced greater savings. Sensitivity analyses revealed budget-impact model sensitivity to the baseline and relative risks of thromboembolic complications. Unfavorable budget impact was found in scenarios exploring an increase in the use of PST alone as well as an increase in the market share of PST and PSM in patients with atrial fibrillation. Conclusions: Overall study findings indicated that PST and PSM are more favorable alternatives to monitoring at specialized centers in patients without atrial fibrillation.
Original languageEnglish
Pages (from-to)383-390
JournalValue in Health
Volume19
Issue number4
DOIs
Publication statusPublished - Jun-2016

Keywords

  • Anticoagulation
  • Budget-impact analysis
  • Patient self-management
  • Patient self-testing
  • Point-of-care devices
  • anticoagulation
  • atrial fibrillation
  • budget
  • controlled study
  • human
  • market
  • meta analysis
  • model
  • monitoring
  • population model
  • risk factor
  • self care
  • self evaluation
  • thromboembolism
  • uncertainty

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