Cost-Effectiveness Analysis of Patient Self-Management for Managing Warfarin in Patients with Non-Valvular Atrial Fibrillation in the US

OBJECTIVES: Patient self-management (PSM) is an alternative strategy to monitor warfarin dosing, allowing patients to adjust warfarin independently of clinician oversight. The purpose of this study was to estimate the costs and outcomes of PSM compared with conventional strategies, including anticoagulation management services (AMS) and usual care (UC) for patients with non-valvular atrial fibrillation (NVAF) in the US, using a societal perspective.

METHODS: A cost-effectiveness analysis was performed to estimate lifetime costs and outcomes of PSM compared with AMS and UC employing a Markov model. The model simulated a 70-year-old with NVAF over the patient’s lifetime. Transition probabilities were derived from individual patient-level data from the University of Utah health system electronic medical records. Comparative efficacy and safety among the interventions were obtained from a network meta-analysis. Costs, presented in 2022 US dollars, and utility data were obtained from data sources in the US. A discount rate of 3% was applied for future costs and outcomes.

RESULTS: The lifetime cost of UC, AMS, and PSM was $517,120, $508,798, and $447,708, respectively. The quality-adjusted life years (QALYs) were estimated to be 6.50 for UC, 6.54 for AMS, and 6.85 for PSM. PSM was cost-saving compared with either UC or AMS. Probabilistic sensitivity analyses revealed that the probability of PSM being cost-effective was 68.8% at the willingness-to-pay threshold of $100,000/QALY.

CONCLUSIONS: PSM is a cost-effective strategy for managing warfarin in patients with NVAF at any willingness-to-pay threshold. Implementation of PSM in the US healthcare setting should be considered.