Anti-coagulant monitoring service delivery: a comparison of costs of hospital and community outreach clinics.

Anti-coagulated patients are monitored at regular intervals to ensure that their warfarin dosage is appropriate for their target International Normalized Ratio. The traditional setting for this monitoring has been the hospital clinic. Technological advances allow-- and with growing numbers of anti-coagulated patients, are leading to-- greater provision of monitoring clinics outside the hospital, at a more convenient location nearer patients' homes. This paper discusses the differences in organization between a hospital clinic and one set in the community (although provided by the hospital), and compares their costs. The comparison demonstrates the greater average cost per appointment in outreach of pound sterling 13.12 under current arrangements. Estimates are presented of incremental cost per appointment of pound sterling 3.93 and pound sterling 15.88 for a 10% increase in weekly patient numbers put through hospital and outreach clinics, respectively. Cost estimates are also presented for suggested alterations to hospital clinics that may reduce patient inconvenience, and the conditions under which outreach provision might be expanded at comparable cost to hospital provision are also examined.