Department of Health Care Management, Wharton School of Business, University of Pennsylvania, Philadelphia, PA 19104-6021, USA.
Pharmacoepidemiol Drug Saf. 2010 Jul;19(7):731-6. doi: 10.1002/pds.1953.
A prior paper from this study demonstrated that patient report of receiving medication instructions from health care professionals is associated with reduced risk of warfarin-related bleeding hospitalizations. The objective of this analysis was to describe the hospitalization costs due to warfarin-related bleeding events in older community-dwelling adults and to estimate the hospitalization costs avoided due to the receipt of medication instruction from different sources.
We estimated the expected hospitalization costs associated with four instruction sources based on the respective incidence rate of observed hospitalizations and mean hospitalization cost for warfarin-related bleeding episodes from a prospective cohort study of beneficiaries of the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE). We estimated hospitalization costs avoided due to each instruction source compared to no instructions using the payer's perspective. We conducted probabilistic sensitivity analysis to account for uncertainty in our parameters.
One hundred twenty-six warfarin-related bleeding hospitalizations occurred during the observation period with a mean cost of $10,819 (SD: $11,536). The mean expected hospitalization cost from a warfarin-related bleeding hospitalization without instruction was $835 per year per person. Hospitalization costs avoided with instruction from a health care professional ranged from $443 to $481 per year per person.
The costs per hospitalization associated with warfarin-related bleeding events are substantial. Instructions for warfarin management from a health care professional may reduce the number of warfarin-related bleeding hospitalizations and associated costs. Investments in interventions to improve communication regarding warfarin management may be justified economically based on the potential cost savings estimated in this study.
本研究之前的一篇论文表明，患者报告从医疗保健专业人员那里收到药物说明与降低华法林相关出血住院风险有关。本分析的目的是描述老年社区居住成年人因华法林相关出血事件导致的住院费用，并估计因从不同来源获得药物说明而避免的住院费用。
我们根据宾夕法尼亚州老年人药物援助合同（PACE）受益人的前瞻性队列研究中观察到的住院率和华法林相关出血事件的平均住院费用，估计了与四种指导来源相关的预期住院费用。我们从付款人的角度估计了与每种指导来源相比无指导情况下避免的住院费用。我们进行概率敏感性分析以考虑我们参数的不确定性。
在观察期间发生了 126 例华法林相关出血性住院治疗，平均费用为 10819 美元（标准差：11536 美元）。没有指导的华法林相关出血性住院治疗的平均预期住院费用为每人每年 835 美元。从医疗保健专业人员获得指导可避免的住院费用每人每年在 443 美元至 481 美元之间。
与华法林相关出血事件相关的每次住院费用都很高。医疗保健专业人员提供的华法林管理说明可能会减少华法林相关出血性住院治疗的数量和相关费用。根据本研究估计的潜在成本节约，基于经济理由投资于改善华法林管理沟通的干预措施可能是合理的。
