Economic Evaluation of Point-of-Care Monitoring Devices for Long-Term Oral Anticoagulation Therapy

Rationale: New technology has made it possible for patients on long-term oral anticoagulation therapy (OAT) to be monitored with portable devices, sometimes in their own homes, rather than having to go to a hospital or laboratory to provide blood by venipuncture. The devices have been on the market for the last decade. Those who administer funds for anticoagulation programs need to know how POC devices compare in cost effectiveness with standard laboratory tests. Objectives: The objective of this report is to assess the cost effectiveness of POC monitoring devices for long-term OAT. Methodology: We did a cost effectiveness analysis in a Canadian context using a decision analytic Markov model. We evaluated the two devices available in Canada: CoaguChek® from Roche Diagnostics and ProTime® from the International Technidyne Corporation, from both a societal and a health care payer perspective. We compared standard care to POC use in two settings: anticoagulation clinics and patient self-testing. Probablistic sensitivity analysis was conducted. Results: The study found that from a publicly funded health care perspective, including nursing home costs, using POC monitors in anticoagulation clinics was cost saving compared to conventional therapy. Using the health care perspective and comparing patient self-testing using POCs with conventional therapy, the cost per additional QALY gained with CoaguChek® is $57,595. (ProTime® was not available in Canada for self-testing at the time our analysis was done.) When a societal perspective is adopted and travel and time costs to patients and their caregivers are included, patient self-testing with CoaguChek® is cost saving. Conclusions: From a publicly funded health care perspective, and including nursing-home costs, using CoaguChek® or ProTime® in anticoagulation clinics is cost saving relative to conventional testing. Patient self-testing with CoaguChek® is not cost saving from a health provider perspective. But from a societal perspective patient self-testing may be cost effective when patient and care-giver time and travel costs are considered.