OBJECTIVES: Vitamin K antagonists (VKA) Oral Anticoagulant Therapy (OAT) is a highly effective therapy for primary and secondary prevention of thromboembolic disorders and vascular disease in general. OAT requires continuous clinical and laboratory monitoring in order to optimize the treatment and achieve the best risk/benefit ratio. Point-of-care devices (POC) can safely and easily monitor VKA efficacy through International Normalized Ratio (INR) detection by portable coagulometers. The aim of this analysis was to compare the “centralized” with the “decentralized” management model.

METHODS: This analysis was conducted in the Regional Healthcare System (RHS) perspective, on the cohort of patients who are taken in charge by the General Practitioners (GP) “COOP Medici 2000” in Siena, Tuscany Italy. We evaluated aggregated economic and epidemiological data related to the management of OAT patients and direct costs related to the monitoring and follow up. Data were collected through aggregated form with questionnaires directed to General Practitioners (GPs), focusing on patients managed in the 2016.

RESULTS: Data were collected by a pool of 753 patients in treatment with Oral Anticoagulants taken in charge by GPs Cooperative in the whole 2016. The implementation of decentralized management model in patient management in OAT generated a reduction in the expenditure charged on Regional Healthcare System. The decentralized management model was a cost-saving choice (€ 289.246).

CONCLUSIONS: These results represent the first comparison analysis of the decentralized organizational model implemented by MMG “COOP Medici 2000” in Siena and may represent a more efficient patient management strategy.