Anticoagulation monitoring by an anticoagulation service is more cost-effective than routine physician care.

BACKGROUND: Vitamin K antagonists (VKAs) are the mainstay of long-term anticoagulation but require careful monitoring for effectiveness and safety. Physicians manage anticoagulation for most patients, although anticoagulation services are becoming increasingly popular. A new anticoagulation service (AS) run by nurses and overseen by a physician was established and its effectiveness vs usual physician care was independently assessed using costs of emergency department (ED) visits and hospitalizations resulting from failure or complication of anticoagulation. We report the results of this independent analysis of anticoagulation monitoring of patients treated with VKAs.
METHODS: The AS-treated patients received VKAs according to a written protocol, whereas physician monitoring was performed according to individual practice. An independent analysis of ED visits and hospitalizations due to complications of anticoagulation in patients receiving long-term VKAs between July 1, 2008, and December 31, 2008, was performed. The average cost of ED visits and hospitalizations was calculated for each patient cohort. The expense of each was amortized for a 12-month period to determine the annual cost of anticoagulation morbidity per 100 patients treated.
RESULTS: Long-term VKAs were used to treat 2397 patients. Physicians managed 2266 patients (95%; group I) and the AS monitored 131 patients (5%; group II). In group I, 247 patients (10.9%) visited the ED, with an average cost of $288 per visit; the ED cost per patient treated was $31. In group II, two patients (1.5%) visited the ED, with an average cost of $139 per patient. The ED cost per patient treated was $2, leading to annual savings of $5800 per 100 patients (P = .0006). Complications of anticoagulation required hospitalization in 289 group I patients (12.8%), with an average cost of $15,125 per hospitalization and $1929 per patient treated and in three group II patients (2.3%), with an average cost of $17,794 per hospitalization and an average cost of $401 per patient treated. When the savings from ED visits and hospitalizations were combined, AS-managed anticoagulation led to annual savings of $305,600 (P = .0004). Subtracting the cost of staff services resulted in a yearly net savings of $241,400 per 100 patients (P ≤ .0001) managed by the AS.
CONCLUSIONS: Management of long-term VKA therapy by an AS using established protocols appears to reduce anticoagulation morbidity and results in significant cost savings by reducing the number of ED visits and hospitalizations.