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ORAL ANTICOAGULANT TREATMENT WITH ANTIVITAMIN K IN ROMANIA. A COST-EFFECTIVENESS ANALYSIS OF USING INR HOME TESTING DEVICES

MARIAN SORIN PAVELIU ^1*, LASLO LORENZOVICI ², CĂTĂLINA TUDOSE ³

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In Romania K antivitamin treatment is still monitored using INR (international normalized ratio) determination in the laboratory. Meanwhile there are available specialized devices that allow INR to be determined at home and thus self-monitoring of the treatment. A Markov model was used to determine the cost-effectiveness of using INR self-monitoring versus monitoring through classical methods. We carried out a budget impact analysis in the case of 1.5% of patients who would benefit from self-monitoring of INR paid by National Health Insurance House. Probabilistic outcomes resulting from setting the acceptability threshold to €30000/QALY, running a cohort with an average age of 65 for a period of 5 cycles (5 years) has led in 75% of cases to an incremental cost-effectiveness ratio (ICER) below the acceptability threshold. The Budget Impact Analysis showed that shifting 1.5% of the current cases on self-determination of INR will require a supplementary expense in the first year of €813640. Starting with the 5th year, the health insurance system will obtain progressive savings of €252419. The study findings showed that in Romania, self-monitoring of INR could be regarded as a cost-effective and sustainable intervention for the patients receiving oral anticoagulant therapy.