PMID- 29025143
OWN - NLM
STAT- MEDLINE
DCOM- 20180703
LR  - 20220331
IS  - 1464-3677 (Electronic)
IS  - 1353-4505 (Linking)
VI  - 29
IP  - 6
DP  - 2017 Oct 1
TI  - Cost-effectiveness of the pharmacist-assisted warfarin monitoring program at a 
      Medical Center in Taiwan.
PG  - 817-825
LID - 10.1093/intqhc/mzx109 [doi]
AB  - OBJECTIVE: To investigate the cost-effectiveness of the first patient self-paying 
      pharmacist-assisted warfarin monitoring (PAWM) program in Taiwan. DESIGN: A 
      Markov model with a 1-month cycle length and a 20-year time horizon was employed 
      in this study. The model is composed of the following eight states: three 
      no-event states (i.e. 'subtherapeutic,' 'within therapeutic' and 
      'supratherapeutic' states), two serious adverse events (AEs) (i.e. bleeding and 
      thromboembolism), two sequelae states and death. The likelihood of events, costs 
      and utilities were derived from local databases and literature, if applicable. 
      This study was conducted with a payer's perspective and all costs were discounted 
      with a rate of 3%. SETTING: A pharmacist-led clinic. PARTICIPANTS: A hypothetical 
      cohort of 10 000 participants. INTERVENTION(S): PAWM versus usual care. MAIN 
      OUTCOME MEASURE(S): Average quality-adjusted life-years (QALYs) gained and cost 
      increments per patient, and incremental cost-effectiveness ratios (ICERs). 
      RESULTS: The PAWM program resulted in an average of 0.13 QALYs gained and a cost 
      increment of NT$53 850 (US$1683) per patient. As the ICER (NT$410 749 [US$12 
      836]) was less than the gross domestic product per capita (NT$631 142 [US$19 
      723]), the PAWM was considered to be very cost-effective. The sensitivity 
      analyses suggested that our result was robust and that the PAWM program had an 
      86% probability of being very cost-effective. CONCLUSIONS: Even if the costs 
      saved from avoiding AEs were thought to be minimal due to the low-medical 
      expenditures in Taiwan, the PAWM program was demonstrated to be economical. 
      According to our findings, the policymakers should consider reimbursing such a 
      service.
CI  - (c) The Author 2017. Published by Oxford University Press in association with the 
      International Society for Quality in Health Care. All rights reserved. For 
      permissions, please e-mail: journals.permissions@oup.com
FAU - Chang, Jen-Yu
AU  - Chang JY
AD  - Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan 
      University, 33, Linsen S. Rd, Taipei 10050, Taiwan.
FAU - Wang, Chi-Chuan
AU  - Wang CC
AD  - Department of Pharmacy, National Taiwan University Hospital, 7, Chung-Shan S. Rd, 
      Taipei 10002, Taiwan.
AD  - School of Pharmacy, College of Medicine, National Taiwan University, 33, Linsen 
      S. Rd, Taipei 10050, Taiwan.
FAU - Kang, Hao-Cheng
AU  - Kang HC
AD  - Department of Pharmacy, National Taiwan University Hospital, 7, Chung-Shan S. Rd, 
      Taipei 10002, Taiwan.
FAU - Shen, Li-Jiuan
AU  - Shen LJ
AD  - Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan 
      University, 33, Linsen S. Rd, Taipei 10050, Taiwan.
AD  - Department of Pharmacy, National Taiwan University Hospital, 7, Chung-Shan S. Rd, 
      Taipei 10002, Taiwan.
AD  - School of Pharmacy, College of Medicine, National Taiwan University, 33, Linsen 
      S. Rd, Taipei 10050, Taiwan.
FAU - Huang, Chih-Fen
AU  - Huang CF
AD  - Department of Pharmacy, National Taiwan University Hospital, 7, Chung-Shan S. Rd, 
      Taipei 10002, Taiwan.
AD  - School of Pharmacy, College of Medicine, National Taiwan University, 33, Linsen 
      S. Rd, Taipei 10050, Taiwan.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Int J Qual Health Care
JT  - International journal for quality in health care : journal of the International 
      Society for Quality in Health Care
JID - 9434628
RN  - 0 (Anticoagulants)
RN  - 5Q7ZVV76EI (Warfarin)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/adverse effects/*economics/therapeutic use
MH  - Cohort Studies
MH  - *Cost-Benefit Analysis
MH  - Drug Monitoring/*methods
MH  - Hemorrhage/chemically induced
MH  - Humans
MH  - Middle Aged
MH  - Models, Economic
MH  - Mortality
MH  - Pharmacists/*economics
MH  - Quality-Adjusted Life Years
MH  - Taiwan
MH  - Thromboembolism/chemically induced
MH  - Warfarin/adverse effects/economics/*therapeutic use
OTO - NOTNLM
OT  - Markov model
OT  - cost-effectiveness
OT  - incremental cost-effectiveness ratio (ICER)
OT  - pharmacist-assisted warfarin monitoring (PAWM)
OT  - warfarin
EDAT- 2017/10/13 06:00
MHDA- 2018/07/04 06:00
CRDT- 2017/10/13 06:00
PHST- 2017/02/23 00:00 [received]
PHST- 2017/07/31 00:00 [accepted]
PHST- 2017/10/13 06:00 [pubmed]
PHST- 2018/07/04 06:00 [medline]
PHST- 2017/10/13 06:00 [entrez]
AID - 4091122 [pii]
AID - 10.1093/intqhc/mzx109 [doi]
PST - ppublish
SO  - Int J Qual Health Care. 2017 Oct 1;29(6):817-825. doi: 10.1093/intqhc/mzx109.