QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Menzin, J. Articles by Kaatz, S. Search for Related Content PubMed PubMed Citation Articles by Menzin, J. Articles by Kaatz, S.

ANTICOAGULATION

Quality of Anticoagulation Control and Costs of Monitoring Warfarin Therapy Among Patients with Atrial Fibrillation in Clinic Settings: A Multi-Site Managed-Care Study

President, Boston Health Economics, Waltham, MA

Luke Boulanger, MA

Director of Analytic Services, Boston Health Economics

Ole Hauch, MD

Director, Health Economics and Outcomes Research, AstraZeneca, LP, Wilmington, DE

Mark Friedman, MD

Medical Director, Boston Health Economics

Cheryl Beadle Marple, MS MPH

at time of writing, Director, Health Economics and Outcomes Research, AstraZeneca, LP

Gail Wygant, RN MS

Director, Cardiovascular, Health Economics and Outcomes Research, AstraZeneca, LP

Judith S Hurley, MS

at time of writing, Senior Research Associate, Lovelace Respiratory Research Institute, Albuquerque, NM

Stephen Pezzella, MD

Chief of Cardiology and Chair of Medical Specialties, Fallon Clinic, Worcester, MA

Scott Kaatz, DO

Associate Residency Program Director, Co-Director Anticoagulation Clinics, Henry Ford Hospital, Detroit, MI

Reprints: Dr. Menzin, Boston Health Economics, 20 Fox Rd., Waltham, MA 02451-1007, fax 781/290-0029, jmenzin{at}bhei.com

BACKGROUND: Warfarin is recommended for prevention of stroke in patients with atrial fibrillation who are at moderate or high risk, but requires intensive management to achieve safe and optimal anticoagulation control. Anticoagulation clinics are often used to administer warfarin therapy more effectively.

OBJECTIVE: To collect data from multiple sites and assess the quality and costs associated with anticoagulation clinic services.

METHODS: A random sample of 600 adults with chronic nonvalvular atrial fibrillation (CNVAF) receiving warfarin was selected from anticoagulation clinics affiliated with 3 health plans. Patients were identified between 1996 and 1998 and followed for up to one year. We assessed the proportion of time that international normalized ratio (INR) values were within the recommended range (2.0–3.0) and the costs of anticoagulation clinic care.

RESULTS: Patients had an average of 18 clinic contacts over a mean duration of follow-up of 10.5 months. On average, patients were within the recommended INR range 62% of this time, with 25% of days below range and 13% above range. The mean per-patient cost of warfarin monitoring over the follow-up period averaged $261 at site A, $305 at site B, and $205 at site C (in 2003 US$). Mean costs for patients treated for one full year were $288, $339, and $216, respectively.

CONCLUSIONS: In 3 geographically diverse health plans, anticoagulation clinics provided a generally higher quality of control than previously reported in other observational studies. This study highlights the costs of obtaining this level of control.

Key Words: anticoagulation, atrial fibrillation, economics, managed care, quality of care

Published Online, February 8, 2005. www.theannals.com, DOI 10.1345/aph.1E169

This article has been cited by other articles:

				S. J. Connolly, J. Pogue, J. Eikelboom, G. Flaker, P. Commerford, M. G. Franzosi, J. S. Healey, S. Yusuf, and on behalf of the ACTIVE W Investigators Benefit of Oral Anticoagulant Over Antiplatelet Therapy in Atrial Fibrillation Depends on the Quality of International Normalized Ratio Control Achieved by Centers and Countries as Measured by Time in Therapeutic Range Circulation, November 11, 2008; 118(20): 2029 - 2037. [Abstract] [Full Text] [PDF]

				Y. Wan, C. Heneghan, R. Perera, N. Roberts, J. Hollowell, P. Glasziou, C. Bankhead, and Y. Xu Anticoagulation Control and Prediction of Adverse Events in Patients With Atrial Fibrillation: A Systematic Review Circ Cardiovasc Qual Outcomes, November 1, 2008; 1(2): 84 - 91. [Abstract] [Full Text] [PDF]

				R. C. Becker, T. W. Meade, P. B. Berger, M. Ezekowitz, C. M. O'Connor, D. A. Vorchheimer, G. H. Guyatt, D. B. Mark, and R. A. Harrington The Primary and Secondary Prevention of Coronary Artery Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 776S - 814S. [Abstract] [Full Text] [PDF]

				M. B Nichol, T. K Knight, T. Dow, G. Wygant, G. Borok, O. Hauch, and R. O'Connor Quality of Anticoagulation Monitoring in Nonvalvular Atrial Fibrillation Patients: Comparison of Anticoagulation Clinic versus Usual Care Ann. Pharmacother., January 1, 2008; 42(1): 62 - 70. [Abstract] [Full Text] [PDF]

				C. van Walraven, A. Jennings, N. Oake, D. Fergusson, and A. J. Forster Effect of Study Setting on Anticoagulation Control: A Systematic Review and Metaregression Chest, May 1, 2006; 129(5): 1155 - 1166. [Abstract] [Full Text] [PDF]