BACKGROUND Atrial fibrillation (AF) represents the most common sustained cardiac arrhythmia. A service evaluation was carried out at an anticoagulation clinic in Newcastle upon-Tyne to explore the efficacy of introducing self-testing of anticoagulation status for AF patients on warfarin. The analysis presented aims to assess the potential cost savings and clinical outcomes associated with introducing self-testing at a clinic in the Northeast of England, and to determine the cost-effectiveness of a redesigned treatment pathway including genetic testing and self-testing components. METHODS Questionnaires were administered to individuals participating in the service evaluation to understand the patient costs associated with clinical monitoring (139 patients), and quality-of-life before and after the introduction of self-testing (varying numbers). Additionally, data on time in therapeutic range (TTR) were captured at multiple time points to identify any change in outcome. Finally, an economic model was developed to assess the cost-effectiveness of introducing a redesigned treatment pathway, including genetic testing and self-testing, for AF patients. RESULTS The average cost per patient of attending the anticoagulation clinic was £16.24 per visit (including carer costs). Costs were higher amongst patients tested at the hospital clinic than those tested at the community clinic. Improvements in quality-of-life across all psychological topics, and improved TTR, were seen following the introduction of self-testing. Results of the cost-effectiveness analysis showed that the redesigned treatment pathway was less costly and more effective than current practice. CONCLUSIONS Allowing AF patients on warfarin to self-test, rather than attend clinic to have their anticoagulation status assessed, has the potential to reduce patient costs. Additionally, self-testing may result in improved quality-of-life and TTR. Introducing genetic testing to guide patient treatment based on sensitivity to warfarin, and applying this in combination with self-testing, may also result in improved patient outcomes and reduced costs to the health service in the long-term.

中文翻译：

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优化房颤抗凝途径的临床疗效和质量：经济分析。

背景技术房颤（AF）代表最常见的持续性心律不齐。在泰恩河畔纽卡斯尔的一家抗凝诊所进行了一项服务评估，以探讨对华法林的房颤患者进行抗凝状态自我测试的功效。提出的分析旨在评估与在英格兰东北部一家诊所进行自我检测相关的潜在成本节省和临床结果，并确定经过重新设计的治疗途径（包括基因检测和自我检测组成部分）的成本效益。方法对参加服务评估的人员进行问卷调查，以了解与临床监测相关的患者费用（139例患者）以及在引入自测之前和之后的生活质量（数量变化）。另外，在多个时间点捕获了治疗范围内的时间数据（TTR），以识别结果的任何变化。最后，开发了一种经济模型来评估为AF患者引入重新设计的治疗途径（包括基因检测和自我检测）的成本效益。结果参加抗凝门诊的每名患者的平均费用为每次访视16.24英镑（包括护理费用）。在医院诊所接受检查的患者中，费用比在社区诊所接受检查的患者高。引入自我测试后，人们发现所有心理话题的生活质量都有所提高，TTR也有所提高。成本效益分析的结果表明，重新设计的治疗途径比目前的实践更便宜，更有效。结论允许接受华法林治疗的房颤患者进行自检，而不是去诊所评估其抗凝状态，有可能降低患者的费用。此外，自检可以改善生活质量和TTR。引入基因检测以基于对华法令的敏感性来指导患者治疗，并将其与自我检测结合使用，从长远来看也可能会改善患者的预后并降低医疗服务成本。