Cost-effectiveness of pharmacist-participated warfarin therapy management in Thailand

Introduction Although pharmacist-participated warfarin therapy management (PWTM) is well established, the economic evaluation of PWTM is still lacking particularly in Asia-Pacific region. The objective of this study was to estimate the cost-effectiveness of PWTM in Thailand using local data where av...

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Main Authors: Surasak Saokaew, Unchalee Permsuwan, Nathorn Chaiyakunapruk, Surakit Nathisuwan, Apichard Sukonthasarn, Napawan Jeanpeerapong
Format: Journal
Published: 2018
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spelling th-cmuir.6653943832-528102018-09-04T09:32:43Z Cost-effectiveness of pharmacist-participated warfarin therapy management in Thailand Surasak Saokaew Unchalee Permsuwan Nathorn Chaiyakunapruk Surakit Nathisuwan Apichard Sukonthasarn Napawan Jeanpeerapong Medicine Introduction Although pharmacist-participated warfarin therapy management (PWTM) is well established, the economic evaluation of PWTM is still lacking particularly in Asia-Pacific region. The objective of this study was to estimate the cost-effectiveness of PWTM in Thailand using local data where available. Methods A Markov model was used to compare lifetime costs and quality-adjusted life years (QALYs) accrued to patients receiving warfarin therapy through PWTM or usual care (UC). The model was populated with relevant information from both health care system and societal perspectives. Input data were obtained from literatures and database analyses. Incremental cost-effectiveness ratios (ICERs) were presented as year 2012 values. A base-case analysis was performed for patients at age 45 years old. Sensitivity analyses including one-way and probabilistic sensitivity analyses were constructed to determine the robustness of the findings. Results From societal perspective, PWTM and UC results in 39.5 and 38.7 QALY, respectively. Thus, PWTM increase QALY by 0.79, and increase costs by 92,491 THB (3,083 USD) compared with UC (ICER 116,468 THB [3,882.3 USD] per QALY gained). While, from health care system perspective, PWTM also results in 0.79 QALY, and increase costs by 92,788 THB (3,093 USD) compared with UC (ICER 116,842 THB [3,894.7 USD] per QALY gained). Thus, PWTM was cost-effective compared with usual care, assuming willingness-to-pay (WTP) of 150,000 THB/QALY. Results were sensitive to the discount rate and cost of clinic set-up. Conclusion Our finding suggests that PWTM is a cost-effective intervention. Policy-makers may consider our finding as part of information in their decision-making for implementing this strategy into healthcare benefit package. Further updates when additional data available are needed. © 2013 Elsevier Ltd. 2018-09-04T09:32:43Z 2018-09-04T09:32:43Z 2013-10-01 Journal 18792472 00493848 2-s2.0-84885179289 10.1016/j.thromres.2013.08.019 https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84885179289&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/52810
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
topic Medicine
spellingShingle Medicine
Surasak Saokaew
Unchalee Permsuwan
Nathorn Chaiyakunapruk
Surakit Nathisuwan
Apichard Sukonthasarn
Napawan Jeanpeerapong
Cost-effectiveness of pharmacist-participated warfarin therapy management in Thailand
description Introduction Although pharmacist-participated warfarin therapy management (PWTM) is well established, the economic evaluation of PWTM is still lacking particularly in Asia-Pacific region. The objective of this study was to estimate the cost-effectiveness of PWTM in Thailand using local data where available. Methods A Markov model was used to compare lifetime costs and quality-adjusted life years (QALYs) accrued to patients receiving warfarin therapy through PWTM or usual care (UC). The model was populated with relevant information from both health care system and societal perspectives. Input data were obtained from literatures and database analyses. Incremental cost-effectiveness ratios (ICERs) were presented as year 2012 values. A base-case analysis was performed for patients at age 45 years old. Sensitivity analyses including one-way and probabilistic sensitivity analyses were constructed to determine the robustness of the findings. Results From societal perspective, PWTM and UC results in 39.5 and 38.7 QALY, respectively. Thus, PWTM increase QALY by 0.79, and increase costs by 92,491 THB (3,083 USD) compared with UC (ICER 116,468 THB [3,882.3 USD] per QALY gained). While, from health care system perspective, PWTM also results in 0.79 QALY, and increase costs by 92,788 THB (3,093 USD) compared with UC (ICER 116,842 THB [3,894.7 USD] per QALY gained). Thus, PWTM was cost-effective compared with usual care, assuming willingness-to-pay (WTP) of 150,000 THB/QALY. Results were sensitive to the discount rate and cost of clinic set-up. Conclusion Our finding suggests that PWTM is a cost-effective intervention. Policy-makers may consider our finding as part of information in their decision-making for implementing this strategy into healthcare benefit package. Further updates when additional data available are needed. © 2013 Elsevier Ltd.
format Journal
author Surasak Saokaew
Unchalee Permsuwan
Nathorn Chaiyakunapruk
Surakit Nathisuwan
Apichard Sukonthasarn
Napawan Jeanpeerapong
author_facet Surasak Saokaew
Unchalee Permsuwan
Nathorn Chaiyakunapruk
Surakit Nathisuwan
Apichard Sukonthasarn
Napawan Jeanpeerapong
author_sort Surasak Saokaew
title Cost-effectiveness of pharmacist-participated warfarin therapy management in Thailand
title_short Cost-effectiveness of pharmacist-participated warfarin therapy management in Thailand
title_full Cost-effectiveness of pharmacist-participated warfarin therapy management in Thailand
title_fullStr Cost-effectiveness of pharmacist-participated warfarin therapy management in Thailand
title_full_unstemmed Cost-effectiveness of pharmacist-participated warfarin therapy management in Thailand
title_sort cost-effectiveness of pharmacist-participated warfarin therapy management in thailand
publishDate 2018
url https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84885179289&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/52810
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