Modeling patients’ time, travel, and monitoring costs in anticoagulation management: societal savings achievable with the shift from warfarin to direct oral anticoagulants
Abstract Background Anticoagulation therapy is used for atrial fibrillation (AF) patients for reducing the risk of cardioembolic complications such as stroke. The previously recommended anticoagulant, warfarin, has a narrow therapeutic window, and it requires regular laboratory monitoring, unlike di...
Published in: | BMC Health Services Research |
---|---|
Main Authors: | , , , , |
Other Authors: | , |
Format: | Article in Journal/Newspaper |
Language: | English |
Published: |
Springer Science and Business Media LLC
2019
|
Subjects: | |
Online Access: | http://dx.doi.org/10.1186/s12913-019-4711-z http://link.springer.com/content/pdf/10.1186/s12913-019-4711-z.pdf http://link.springer.com/article/10.1186/s12913-019-4711-z/fulltext.html |
id |
crspringernat:10.1186/s12913-019-4711-z |
---|---|
record_format |
openpolar |
spelling |
crspringernat:10.1186/s12913-019-4711-z 2023-05-15T17:00:14+02:00 Modeling patients’ time, travel, and monitoring costs in anticoagulation management: societal savings achievable with the shift from warfarin to direct oral anticoagulants Leminen, Aapeli Pyykönen, Mikko Tynkkynen, Juho Tykkyläinen, Markku Laatikainen, Tiina Strategic Research Council at the Academy of Finland the Faculty of Social Sciences and Business Studies at the University of Eastern Finland 2019 http://dx.doi.org/10.1186/s12913-019-4711-z http://link.springer.com/content/pdf/10.1186/s12913-019-4711-z.pdf http://link.springer.com/article/10.1186/s12913-019-4711-z/fulltext.html en eng Springer Science and Business Media LLC http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/licenses/by/4.0/ CC-BY BMC Health Services Research volume 19, issue 1 ISSN 1472-6963 Health Policy journal-article 2019 crspringernat https://doi.org/10.1186/s12913-019-4711-z 2022-01-04T15:02:38Z Abstract Background Anticoagulation therapy is used for atrial fibrillation (AF) patients for reducing the risk of cardioembolic complications such as stroke. The previously recommended anticoagulant, warfarin, has a narrow therapeutic window, and it requires regular laboratory monitoring, unlike direct oral anticoagulants (DOAC). From a societal perspective, it is important to measure time and travel costs associated with warfarin monitoring to better compare the total therapy costs of these two alternative forms of anticoagulation management. In this study we design a georeferenced cost model to investigate societal savings achievable with the shift from warfarin to DOACs in the study region of North Karelia in Eastern Finland. Methods Individual-level patient data of 6519 AF patients was obtained from the regional patient database. Patients’ geocoded home addresses and other GIS data were used to perform a network analysis for the optimal routes for warfarin monitoring visits. These measures of revealed accessibility were then used in the cost model to measure monetary time and travel costs in addition to direct healthcare costs of anticoagulation management. Results The share of time and travel costs in warfarin monitoring is 26.6% of the total therapy costs in our study region. With current drug retail prices in Finland, the societal expense of anticoagulation management is only 2.6% higher with DOACs than in the baseline with warfarin. However, when 25% lower distributor’s prices are used, the total societal cost decreases by 13.6% with DOACs. Conclusions Our results indicate that patients’ time and travel costs critically increase the societal cost of warfarin therapy; and despite the higher price of DOACs, they are already cost-efficient alternatives to warfarin in anticoagulation management. In the future, the cost of AF complications should be included in the cost comparison between warfarin and DOACs. Our modeling approach applies to different geographical regions and to different healthcare processes requiring patient monitoring. Article in Journal/Newspaper karelia* Springer Nature (via Crossref) BMC Health Services Research 19 1 |
institution |
Open Polar |
collection |
Springer Nature (via Crossref) |
op_collection_id |
crspringernat |
language |
English |
topic |
Health Policy |
spellingShingle |
Health Policy Leminen, Aapeli Pyykönen, Mikko Tynkkynen, Juho Tykkyläinen, Markku Laatikainen, Tiina Modeling patients’ time, travel, and monitoring costs in anticoagulation management: societal savings achievable with the shift from warfarin to direct oral anticoagulants |
topic_facet |
Health Policy |
description |
Abstract Background Anticoagulation therapy is used for atrial fibrillation (AF) patients for reducing the risk of cardioembolic complications such as stroke. The previously recommended anticoagulant, warfarin, has a narrow therapeutic window, and it requires regular laboratory monitoring, unlike direct oral anticoagulants (DOAC). From a societal perspective, it is important to measure time and travel costs associated with warfarin monitoring to better compare the total therapy costs of these two alternative forms of anticoagulation management. In this study we design a georeferenced cost model to investigate societal savings achievable with the shift from warfarin to DOACs in the study region of North Karelia in Eastern Finland. Methods Individual-level patient data of 6519 AF patients was obtained from the regional patient database. Patients’ geocoded home addresses and other GIS data were used to perform a network analysis for the optimal routes for warfarin monitoring visits. These measures of revealed accessibility were then used in the cost model to measure monetary time and travel costs in addition to direct healthcare costs of anticoagulation management. Results The share of time and travel costs in warfarin monitoring is 26.6% of the total therapy costs in our study region. With current drug retail prices in Finland, the societal expense of anticoagulation management is only 2.6% higher with DOACs than in the baseline with warfarin. However, when 25% lower distributor’s prices are used, the total societal cost decreases by 13.6% with DOACs. Conclusions Our results indicate that patients’ time and travel costs critically increase the societal cost of warfarin therapy; and despite the higher price of DOACs, they are already cost-efficient alternatives to warfarin in anticoagulation management. In the future, the cost of AF complications should be included in the cost comparison between warfarin and DOACs. Our modeling approach applies to different geographical regions and to different healthcare processes requiring patient monitoring. |
author2 |
Strategic Research Council at the Academy of Finland the Faculty of Social Sciences and Business Studies at the University of Eastern Finland |
format |
Article in Journal/Newspaper |
author |
Leminen, Aapeli Pyykönen, Mikko Tynkkynen, Juho Tykkyläinen, Markku Laatikainen, Tiina |
author_facet |
Leminen, Aapeli Pyykönen, Mikko Tynkkynen, Juho Tykkyläinen, Markku Laatikainen, Tiina |
author_sort |
Leminen, Aapeli |
title |
Modeling patients’ time, travel, and monitoring costs in anticoagulation management: societal savings achievable with the shift from warfarin to direct oral anticoagulants |
title_short |
Modeling patients’ time, travel, and monitoring costs in anticoagulation management: societal savings achievable with the shift from warfarin to direct oral anticoagulants |
title_full |
Modeling patients’ time, travel, and monitoring costs in anticoagulation management: societal savings achievable with the shift from warfarin to direct oral anticoagulants |
title_fullStr |
Modeling patients’ time, travel, and monitoring costs in anticoagulation management: societal savings achievable with the shift from warfarin to direct oral anticoagulants |
title_full_unstemmed |
Modeling patients’ time, travel, and monitoring costs in anticoagulation management: societal savings achievable with the shift from warfarin to direct oral anticoagulants |
title_sort |
modeling patients’ time, travel, and monitoring costs in anticoagulation management: societal savings achievable with the shift from warfarin to direct oral anticoagulants |
publisher |
Springer Science and Business Media LLC |
publishDate |
2019 |
url |
http://dx.doi.org/10.1186/s12913-019-4711-z http://link.springer.com/content/pdf/10.1186/s12913-019-4711-z.pdf http://link.springer.com/article/10.1186/s12913-019-4711-z/fulltext.html |
genre |
karelia* |
genre_facet |
karelia* |
op_source |
BMC Health Services Research volume 19, issue 1 ISSN 1472-6963 |
op_rights |
http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/licenses/by/4.0/ |
op_rightsnorm |
CC-BY |
op_doi |
https://doi.org/10.1186/s12913-019-4711-z |
container_title |
BMC Health Services Research |
container_volume |
19 |
container_issue |
1 |
_version_ |
1766052869622988800 |