BACKGROUND: A disease model was developed to compare clinical and economic outcomes of home monitoring versus ambulant monitoring in anticoagulation patients with heart valve implants in two different locations. The improved outcomes seen with home monitoring result from tighter control of the anticoagulation (AC) level. Thereby a higher proportion of patients is kept within the therapeutic INR target range leading to a decreased incidence of adverse events. OBJECTIVE: The model compares the event-rates of major thromboembolic events (TE), major bleeding (BL) complications and mortality rates in cohorts with mechanical heart valve replacement requiring oral anticoagulation with warfarin. METHODS: The AC monitoring strategies compared were A) 52 times / year home monitoring of AC with the CoaguChek home-monitor, and B) monthly monitoring in an outpatient clinic (with laboratory tested AC levels). Direct costs of basic treatment, patient education and monitoring, as well as treatment costs of complications were collected from the Swiss third party payer perspective. Complication rates (TE, BL, mortality) were derived from published literature and official agency reports. The health economic analysis simulated an observational time of 10 years. Cost outcomes were discounted at a real annual rate of 5 %. RESULTS: Self-monitoring by patients reduces the total costs (monitoring and complication related costs) per patient from Swiss Francs (CHF) 8’988 to CHF 7’532 per patient over the observation time of 10 years. Sensitivity analysis were performed and identified the main cost drivers as: frequency of home monitoring, cost per home monitoring test, cost and durability of home monitoring device. CONCLUSION: Demonstrated within the limitations of the modelling approach, the application of home monitoring in heart valve implant patients is dominant to ambulant monitoring in outpatient clinics, with increased life quality and decreased overall costs.