Abstract
In this study, the cost-effectiveness of anticoagulation self-management-which is
now established in Germany-was compared with the conventional method of monitoring
oral anticoagulant therapy by the patient's family physician or by a specialist. Costs
were determined based on the usual conditions in Germany such as frequency of testing
and control testing, scope of the tests, and diagnostic and therapeutic standards
for thromboembolic or bleeding complications. In addition to direct monitoring costs,
we determined the costs for treating minor and serious complications and used them
to calculate overall therapy costs. The incidence of complications was estimated based
on the results of more recent studies. The only costs considered in this study were
those covered by the primary cost carrier-the government-controlled health insurance
funds-and included outpatient visits and, in cases of serious complications, acute
inpatient treatment and rehabilitation. It was shown that the costs to treat minor
complications only slightly affected annual, overall treatment costs. The potential
reduction in incidences of serious bleeding and thromboembolic complications due to
anticoagulation self-management-which is independent of the indication for oral anticoagulation-reduced
overall therapy costs from DM 2,061.48/patient-year for conventional therapeutic methods
to DM 1,342.46/patient-year for patients under self-management of anticoagulation.
Keywords:
Cost-effectiveness - patient self-management - oral anticoagulation - bleeding - thromboembolism
