Cost-Effectiveness Analysis of Patient Self-Management of Warfarin Among Patients With Non-Valvular Atrial Fibrillation.

BACKGROUND

Patient self-management (PSM) is a warfarin management strategy that allows patients to independently adjust their doses. PSM significantly reduces thrombosis events and has been widely implemented internationally. However, adoption of PSM is limited in the United States. This study estimated the cost-effectiveness of PSM compared with available strategies, including anticoagulation management services (AMS) and usual care (UC) for patients with non-valvular atrial fibrillation (NVAF) aged 70 years and older in the United States.

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 from modified societal and payer perspectives. Transition probabilities were derived from annual event rates reported in the ARISTOTLE trial. Comparative efficacy and safety among the interventions were obtained from a network meta-analysis. Costs, presented in 2024 US dollars (USD), and utility data were obtained from data sources in the United States. A discount rate of 3% was applied for future costs and outcomes. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to assess the robustness of the findings.

RESULTS

The lifetime costs from the modified societal perspective were $137,509 USD for UC, $129,216 USD for AMS, and $76,515 USD for PSM. Discounted quality-adjusted life years (QALYs) were estimated to be 8.27 for UC, 8.30 for AMS, and 8.47 for PSM. Additionally, PSM substantially reduced stroke incidence compared with AMS and UC, contributing to lower costs and greater QALYs. Probabilistic sensitivity analysis showed that PSM appeared to be the most cost-effective at any willingness-to-pay threshold.

CONCLUSIONS

PSM is the most cost-effective strategy for managing warfarin in the target population at any willingness-to-pay threshold. Implementation of PSM in the US health care setting should be considered.