Cost-effectiveness of pharmacist-participated warfarin therapy management in Thailand

Saokaew, Surasak, Permsuwan, Unchalee, Chaiyakunapruk, Nathorn, Nathisuwan, Surakit, Sukonthasarn, Apichard and Jeanpeerapong, Napawan (2013) Cost-effectiveness of pharmacist-participated warfarin therapy management in Thailand. Thrombosis Research, 132 4: 437-443. doi:10.1016/j.thromres.2013.08.019


Author Saokaew, Surasak
Permsuwan, Unchalee
Chaiyakunapruk, Nathorn
Nathisuwan, Surakit
Sukonthasarn, Apichard
Jeanpeerapong, Napawan
Title Cost-effectiveness of pharmacist-participated warfarin therapy management in Thailand
Journal name Thrombosis Research   Check publisher's open access policy
ISSN 0049-3848
1879-2472
Publication date 2013-10
Year available 2013
Sub-type Article (original research)
DOI 10.1016/j.thromres.2013.08.019
Open Access Status
Volume 132
Issue 4
Start page 437
End page 443
Total pages 7
Place of publication Kidlington, Oxford, United Kingdom
Publisher Pergamon
Collection year 2014
Language eng
Formatted abstract
Introduction
Although pharmacist-participated warfarin therapy management (PWTM) is well established, the economic evaluation of PWTM is still lacking particularly in Asia-Pacific region. The objective of this study was to estimate the cost-effectiveness of PWTM in Thailand using local data where available.

Methods
A Markov model was used to compare lifetime costs and quality-adjusted life years (QALYs) accrued to patients receiving warfarin therapy through PWTM or usual care (UC). The model was populated with relevant information from both health care system and societal perspectives. Input data were obtained from literatures and database analyses. Incremental cost-effectiveness ratios (ICERs) were presented as year 2012 values. A base-case analysis was performed for patients at age 45 years old. Sensitivity analyses including one-way and probabilistic sensitivity analyses were constructed to determine the robustness of the findings.

Results
From societal perspective, PWTM and UC results in 39.5 and 38.7 QALY, respectively. Thus, PWTM increase QALY by 0.79, and increase costs by 92,491 THB (3,083 USD) compared with UC (ICER 116,468 THB [3,882.3 USD] per QALY gained). While, from health care system perspective, PWTM also results in 0.79 QALY, and increase costs by 92,788 THB (3,093 USD) compared with UC (ICER 116,842 THB [3,894.7 USD] per QALY gained). Thus, PWTM was cost-effective compared with usual care, assuming willingness-to-pay (WTP) of 150,000 THB/QALY. Results were sensitive to the discount rate and cost of clinic set-up.

Conclusion
Our finding suggests that PWTM is a cost-effective intervention. Policy-makers may consider our finding as part of information in their decision-making for implementing this strategy into healthcare benefit package. Further updates when additional data available are needed.
Keyword Anticoagulation clinic
Bleeding
Cost-effectiveness
Pharmacist
Thromboembolism
Warfarin
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Public Health Publications
 
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