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Which approach to anticoagulation management is best? Illustration of an interactive mathematical model to support informed decision making.

Publication ,  Journal Article
Samsa, GP; Matchar, DB; Phillips, DL; McGrann, J
Published in: J Thromb Thrombolysis
October 2002

BACKGROUND: Among patients with atrial fibrillation or mechanical heart valves, determining the best approach to oral anticoagulation largely depends on comparing the costs of anticoagulation management with the costs of events (thromboembolism and bleeding) averted. The Anticoagulation Management Event/Cost Model (ACME) is an interactive mathematical model intended to help clarify these trade-offs. METHODS: The ACME is a series of linked, nested spreadsheets. At the least detailed level, the user specifies the percentage of patients falling into various management strategies (no anticoagulation, usual physician care, anticoagulation service, patient self-testing/self-management), and the ACME estimates event rates and costs. At more detailed levels the ACME performs a series of weighted average calculations combining, for example, utilization times unit price. Cost categories are divided into event-related and management-related costs (costs of management, testing, and medication). RESULTS: Regardless of how anticoagulation is subsequently managed, perhaps the greatest benefit is obtained by moving patients who are not currently receiving anticoagulation onto warfarin. Additional benefits can be obtained by eliminating outliers (extremely high or extremely low anticoagulation levels). If changing to a more intensive approach also serves to reduce the tendency for physicians to prescribe anticoagulate below the optimal range, additional savings can be anticipated. The cost calculation typically involves a trade-off between increased up-front costs of anticoagulation management versus greater down-line savings associated with a decreased number of events. To assess the quality of anticoagulation within a given organization, it is critical to know the distribution of clotting levels for the population under anticoagulation. CONCLUSIONS: Interactive mathematical models, if sufficiently well documented, can be helpful in clarifying decisions regarding costs and benefits of various methods of anticoagulation.

Duke Scholars

Published In

J Thromb Thrombolysis

DOI

ISSN

0929-5305

Publication Date

October 2002

Volume

14

Issue

2

Start / End Page

103 / 111

Location

Netherlands

Related Subject Headings

  • Models, Statistical
  • International Normalized Ratio
  • Humans
  • Disease Management
  • Decision Support Techniques
  • Decision Making
  • Cardiovascular System & Hematology
  • Blood Coagulation Disorders
  • Anticoagulants
  • 3202 Clinical sciences
 

Citation

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Samsa, G. P., Matchar, D. B., Phillips, D. L., & McGrann, J. (2002). Which approach to anticoagulation management is best? Illustration of an interactive mathematical model to support informed decision making. J Thromb Thrombolysis, 14(2), 103–111. https://doi.org/10.1023/a:1023276710895
Samsa, Gregory P., David B. Matchar, David L. Phillips, and Jack McGrann. “Which approach to anticoagulation management is best? Illustration of an interactive mathematical model to support informed decision making.J Thromb Thrombolysis 14, no. 2 (October 2002): 103–11. https://doi.org/10.1023/a:1023276710895.
Samsa GP, Matchar DB, Phillips DL, McGrann J. Which approach to anticoagulation management is best? Illustration of an interactive mathematical model to support informed decision making. J Thromb Thrombolysis. 2002 Oct;14(2):103–11.
Samsa, Gregory P., et al. “Which approach to anticoagulation management is best? Illustration of an interactive mathematical model to support informed decision making.J Thromb Thrombolysis, vol. 14, no. 2, Oct. 2002, pp. 103–11. Pubmed, doi:10.1023/a:1023276710895.
Samsa GP, Matchar DB, Phillips DL, McGrann J. Which approach to anticoagulation management is best? Illustration of an interactive mathematical model to support informed decision making. J Thromb Thrombolysis. 2002 Oct;14(2):103–111.
Journal cover image

Published In

J Thromb Thrombolysis

DOI

ISSN

0929-5305

Publication Date

October 2002

Volume

14

Issue

2

Start / End Page

103 / 111

Location

Netherlands

Related Subject Headings

  • Models, Statistical
  • International Normalized Ratio
  • Humans
  • Disease Management
  • Decision Support Techniques
  • Decision Making
  • Cardiovascular System & Hematology
  • Blood Coagulation Disorders
  • Anticoagulants
  • 3202 Clinical sciences