The demand for anticoagulation management is increasing because of a widening of the indications of treatment. A primary care clinic using near-patient testing and computer decision support software is one model of care to meet this increased demand. The study aimed to determine the cost and cost-effectiveness of primary care-based anticoagulation management in comparison with 'traditional' hospital care-based provision by means of a cost-effectiveness analysis using data from a Birmingham-based multicentre randomized controlled trial. The costs per patient per year in primary care were pound170 [95% confidence interval (CI) pound149-190] vs. pound69 (95% CI pound57-81). Sensitivity analysis demonstrated that the cost in primary care could be reduced to under pound100 per patient per year under plausible changes in the variables. Primary care provides similar levels of control to secondary care for patients on anticoagulation therapy. There is an increased cost of managing patients in primary care and at no point did primary care become a lower cost option than secondary care. Local decision-makers need to assess the increased cost of primary care anticoagulation management in terms of the potential reductions in high-cost serious adverse events.

et al.The costeffectiveness of magnetic resonance imaging for investigation of the knee joint. Health Technol Assess 2001;5(27). Health Technology Assessment is indexed in Index Medicus/MEDLINE and Excerpta Medica/ EMBASE. Copies of the Executive Summaries are available from the NCCHTA website (see opposite). NHS R&D HTA Programme T he NHS R&D Health Technology Assessment (HTA) Programme was set up in 1993 to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and provide care in the NHS. Initially, six HTA panels (pharmaceuticals, acute sector, primary and community care, diagnostics and imaging, population screening, methodology) helped to set the research priorities for the HTA Programme. However, during the past few years there have been a number of changes in and around NHS R&D, such as the establishment of the National Institute for Clinical Excellence (NICE) and the creation of three new research programmes: Service Delivery and Organisation (SDO); New and Emerging Applications of Technology (NEAT); and the Methodology Programme. This has meant that the HTA panels can now focus more explicitly on health technologies ('health technologies' are broadly defined to include all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care) rather than settings of care. Therefore the panel structure has been redefined and replaced by three new panels: Pharmaceuticals; Therapeutic Procedures (including devices and operations); and Diagnostic Technologies and Screening. The HTA Programme will continue to commission both primary and secondary research. The HTA Commissioning Board, supported by the National Coordinating Centre for Health Technology Assessment (NCCHTA), will consider and advise the Programme Director on the best research projects to pursue in order to address the research priorities identified by the three HTA panels. The research reported in this monograph was funded as project number 93/26/16. The views expressed in this publication are those of the authors and not necessarily those of the HTA Programme or the Department of Health. The editors wish to emphasise that funding and publication of this research by the NHS should not be taken as implicit support for any recommendations made by the authors. Criteria for inclusion in the HTA monograph series Reports are published in the HTA monograph series if (1) they have resulted from work commissioned for the HTA Programme, and (2) they are of a sufficiently high scientific quality as assessed by the referees and editors. Reviews in Health Technology Assessment are termed 'systematic' when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others.

Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph.You can order HTA monographs from our Despatch Agents, York Publishing Services by:-fax (with credit card or official purchase order) -post (with credit card or official purchase order or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. NHS and public libraries can subscribe at a very reduced cost of £100 for each volume (normally comprising 30-40 titles). The commercial subscription rate is £300 per volume. Please contact York Publishing Services at the address above. Subscriptions can only be purchased for the current or forthcoming volume. Contact details are as follows: Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to York Publishing Distribution and drawn on a bank with a UK address. Paying by credit cardThe following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email. Paying by official purchase orderYou can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK. We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD?Please use the form on the HTA website (www.ncchta.org/htacd.htm). Or contact York Publishing Services (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide.The website also provides information about the HTA Programme and lists the membership of the various committees. HTAEffectiveness of autologous chondrocyte transplantation for hyaline cartilage defects in knees: a rapid and systematic review This report should be referenced as follows:Jobanputra P, Parry D, Fry-Smith A, Burls A. Effectiveness of autologous chondrocyte transplantation for hyaline cartilage defects in knees: a rapid and systematic review. Health Technol Assess 2001;5(11).Health Technology Assessment is indexed in Index Medicus/MEDLINE and Excerpta Medica/ EMBASE. Copies of the Executive Summaries are available from the NCCHTA website (see opposite). NHS R&D HTA ProgrammeT he NHS R&D Health Technology Assessment (HTA) Programme was set up in 1993 to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and provide care in the NHS.The research reported in this monograph was commissioned by the HTA Programme on behalf of the National Institute for Clinical Excellence (NICE). Rapid reviews are completed in a limited time to inform the appraisal and guideline development processes managed by NICE. The review brings together evidence on key aspects of t...

No abstract

Summary. The demand for anticoagulation management is increasing because of a widening of the indications of treatment. A primary care clinic using near-patient testing and computer decision support software is one model of care to meet this increased demand. The study aimed to determine the cost and cost-effectiveness of primary carebased anticoagulation management in comparison with traditional' hospital care-based provision by means of a cost-effectiveness analysis using data from a Birminghambased multicentre randomized controlled trial. The costs per patient per year in primary care were £170 [95% confidence interval (CI) £149±190] vs. £69 (95% CI £57±81). Sensitivity analysis demonstrated that the cost in primary care could be reduced to under £100 per patient per year under plausible changes in the variables. Primary care provides similar levels of control to secondary care for patients on anticoagulation therapy. There is an increased cost of managing patients in primary care and at no point did primary care become a lower cost option than secondary care. Local decision-makers need to assess the increased cost of primary care anticoagulation management in terms of the potential reductions in high-cost serious adverse events.Keywords: economic evaluation, anticoagulation, warfarin, primary care, secondary care.The continuing expansion of clinical indications for warfarin (particularly non-rheumatic atrial fibrillation) has greatly increased the pressure on hospital anticoagulation management services (Sudlow et al, 1995;Sweeney et al, 1995). In response, various efforts have been undertaken to provide care in non-hospital settings. Studies have demonstrated that care within non-hospital settings can be at least as good as hospital care in terms of International Normalized Ratio (INR) control and the incidence of adverse events (Pell et al, 1993;Radley, 1995;Fitzmaurice et al, 1997). There has been little research, however, into the cost implications of devolving anticoagulation care into the community. This paper provides a report of an economic evaluation of one new model of care: a practice nurse-led, primary care clinic utilizing nearpatient testing for INR testing combined with a computerized decision support system to assist with warfarin dosing (hereafter primary care) which was compared with conventional hospital management. METHODSThe economic evaluation used data from a Birminghambased multicentre randomized controlled trial which is reported in full elsewhere (Fitzmaurice et al, 2000). Patients were randomized either to the primary care intervention arm or to the hospital control arm. The clinical study was powered to detect a 20% difference in INR control at 5% significance, and analysis was on an intention-to-treat basis. For the economic evaluation power calculation, a £25 difference in the cost per patient per annum was taken to be a significant cost difference, which at 80% power and 5% significance required 63 patients in each arm of the trial. Effectiveness was measured by the proportion ...