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Background: novel oral anticoagulants may be particularly
cost-effective when INR control (TTR) with warfarin is poor or monitoring
difficult
Setting: the Newcastle upon Tyne monitoring service, set
in hospital or general practice and a domiciliary-based service for
housebound patients
Objectives: to
examine anticoagulation stability and costs of monitoring
Subjects: three
hundred and twenty-six atrial fibrillation patients, 75 years and over, with
target INR of two to three, accessing hospital (n = 100), general practice (n
= 122) and domiciliary (n = 104) service
Methods: age, co-morbidities, length of warfarin
treatment, medications, INR values and dose changes from January to December
2011 were recorded, and costs analysed
Results:
home-monitored patients had taken warfarin for longer, mean 5.2 years, than
hospital (3.7) or general practice (3.1) patients. Age and total number of
drugs prescribed chronically were negatively related to TTR. INR measurements
and dose changes were negatively associated with the duration of treatment,
positively correlated with co-morbidities. The mean TTR was 78% in hospital,
71% in general practice and 68% in domiciliary monitored patients. INR was monitored
more often in hospital and domiciliary groups than in general practice and
more dose changes occurred in the domiciliary group than in others. Costs of
warfarin and monitoring were £128 per patient per year for hospital, £126 for
general practice and £222 for domiciliary patients
Conclusions: further exploration of the clinical
effectiveness of novel anticoagulants in dependent patients is warranted to
determine to what extent trial outcomes so far achieved in a fitter elderly
population are influenced by the chronic co-morbidities of old age
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