Gebruik van point-of care systemen bij patiënten met orale ... - KCE

KCE Reports 117 POC Anticoagulation 137
Authors (Year) Claes N, Moeremans K, Buntinx F, Arnout J, Vermylen J, Van Loon H, Annemans
L (2006).
Funding No funding.
Country Belgium.
Design CEA, RCT BISOAT (+retrospective analysis for usual care).
Perspective Health care payer.
Time window 6 months.
Interventions Usual care : Management by a GP (2.6 tests/month) versus : (1) Management by a
General Practitioner (GP) + patient and GP education on oral anticoagulation
(2.2 tests/month). (2) Management by a GP + patient and GP education on oral
anticoagulation + feedback on coagulation performance every 2 months
(comparison of GP practice performance with the mean clinical performance of
the group) (2.2 tests/month). (3) Management by a GP using POC device
(CoaguChek) + patient and GP education on oral anticoagulation (2.6
tests/month). (4) Management by a GP + use of a Dawn AC computer assisted
advice + patient and GP education on oral anticoagulation (1.9 tests/month). NB:
The proportion of patient visits at home was 30% and at the GP office was 70%.
Population 834 patients on Oral anticoagulation therapy for at least 28 days and 66 GP.
Assumptions /
Data source for costs Interviews and RCT [Claes 2005] 84 .
Cost items included (Activity-based costing method). Direct health care costs for anticoagulation
testing, monitoring, and training (Labor, consumable, capital and overheads).
Patients’ transportation time and costs; and productivity losses are excluded. For
laboratory tests, a lump-sum is foreseen to represent overhead costs.
Data source for outcomes RCT [Claes 2005] 84 .
Discounting Not appropriate.
Costs. NB: Cost over 6 Usual care : €4,080 / (1): €5,046 (Incremental cost: €966) / (2): €5,122
months per GP.
(Incremental cost: €1,042) / (3): € 3,993 (Incremental cost: -€87) / (4. €5,323
(Incremental cost: €1,243).
Outcomes. NB: Outcomes Absolute number of additional days within a 0.5 range from the INR target: (1):
over 6 months per GP. 185 (95%CI: 46 to 311) / (2): 208 (95%CI: 92 to 311) / (3) 254 (95%CI: 138 to
381) / (4) 254 (95%CI: 127 to 381).
Cost-effectiveness Incremental cost per additional day within a 0.5 range from the INR target.
Compared to usual care: (1) €5.23/day / (2) €5.02/day / (3) Dominant strategy /
(4) €4.90/day.
Sensitivity analysis If the limits of the 95%CI of outcomes were tested, the ICER of the strategy (1)
was the most unstable (from €3.1/day to €20.93/day) because the range of CI
outcome values for this group was large. If equal amount of tests were used
between the strategies, the ICERs for (1), (2) and almost (4) get worse. Inclusion
of overhead costs for laboratory test has an important impact on the strategy
(3); By reducing these costs, the strategy (3) is not anymore a cost-effective
strategy. Finally, increasing the timeframe, the number of GP or the number of
patients per GP improved the ICER.
Conclusions A GP management using the CoaguChek device in combination with a
multifaceted education is a cost-saving alternative for usual care and the Belgian
health-care payers have to consider reimbursement for this strategy.