https://scholars.lib.ntu.edu.tw/handle/123456789/531100
標題: | Cost-effectiveness of the pharmacist-assisted warfarin monitoring program at a Medical Center in Taiwan | 作者: | Chang J.-Y. CHI-CHUAN WANG Kang H.-C. LI-JIUAN SHEN CHIH-FEN HUANG |
公開日期: | 2017 | 卷: | 29 | 期: | 6 | 起(迄)頁: | 817-825 | 來源出版物: | International Journal for Quality in Health Care | 摘要: | 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 costeffective. 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. ? The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/531100 | ISSN: | 13534505 | DOI: | 10.1093/intqhc/mzx109 | SDG/關鍵字: | warfarin; anticoagulant agent; warfarin; adult; aged; Article; cost benefit analysis; cost control; cost effectiveness analysis; drug effect; drug surveillance program; human; major clinical study; middle aged; pharmacist; priority journal; quality adjusted life year; reimbursement; sensitivity analysis; Taiwan; thromboembolism; very elderly; bleeding; chemically induced; cohort analysis; cost benefit analysis; drug monitoring; economic model; economics; mortality; pharmacist; procedures; thromboembolism; Aged; Aged, 80 and over; Anticoagulants; Cohort Studies; Cost-Benefit Analysis; Drug Monitoring; Hemorrhage; Humans; Middle Aged; Models, Economic; Mortality; Pharmacists; Quality-Adjusted Life Years; Taiwan; Thromboembolism; Warfarin |
顯示於: | 臨床藥學研究所 |
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