Transportation Cost of Anticoagulation Clinic Visits in an Urban Setting

Hwang, Jamie M.; Clemente, Jennifer L.; Sharma, Krishna P.; Taylor, Thomas N.; Garwood, Candice L.

doi:10.18553/jmcp.2011.17.8.635

Cited by 14 publications

(11 citation statements)

References 9 publications

(5 reference statements)

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“…29 Another cost of regular laboratory monitoring to consider is the cost to patients, such as the cost of transportation and time lost from work. Hwang et al (2011) determined the average cost of round-trip transportation to be $10.78 in 2010 U.S. dollars weighted for all transportation modes based on a 60-patient survey at an urban anticoagulation clinic. 49 The annual cost of round-trip transportation ranged from $130 (monthly appointments) to $560 (weekly appointments).…”

Section: ■■ Discussionmentioning

confidence: 99%

“…Hwang et al (2011) determined the average cost of round-trip transportation to be $10.78 in 2010 U.S. dollars weighted for all transportation modes based on a 60-patient survey at an urban anticoagulation clinic. 49 The annual cost of round-trip transportation ranged from $130 (monthly appointments) to $560 (weekly appointments). Since most participants were unemployed or retired, only 7 of the 60 participants took time off from work for clinic visits.…”

Section: ■■ Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cost Implications of Formulary Decisions on Oral Anticoagulants in Nonvalvular Atrial Fibrillation

Biskupiak¹,

Ghate²,

Jiao³

et al. 2013

JMCP

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In the European Union, 4.5 million people are estimated to have AF.2 Patients with untreated AF are at a 4-to 5-fold increased risk of stroke compared with those without the disease. Vitamin K antagonists (VKAs), such as warfarin, have been successfully used for many years to provide prophylaxis against stroke in patients with AF. A large meta-analysis of randomized trials showed that adjusted-dose warfarin reduced the incidence of stroke by 64%. 4 However, in a real-world analysis of Medicare patients with AF, the reduction in stroke with warfarin was lower than in the meta-analysis, at 27%. 5While effective, VKAs are associated with a number of limitations: they have numerous drug and food interactions; their effect is influenced by genetic factors; and they have a narrow therapeutic range, requiring frequent international normalized ratio (INR) monitoring and dose adjustments.6 As a result of these factors, there is considerable variability in the amount of time patients spend within the therapeutic range (INR, 2.0-3.0), which exposes them to stroke when they are below the range and bleeding when they are above the range.New anticoagulants have been developed to reduce the risk of stroke in patients with AF. These oral agents are direct inhibitors of single coagulation factors and include dabigatran, rivaroxaban, and apixaban.7 They meet the need for predictable anticoagulation with fixed dosing, without the need for laboratory monitoring. As may be expected, these anticoagulants are more expensive per unit than warfarin.7 However, the

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Section: ■■ Discussionmentioning

confidence: 99%

Section: ■■ Discussionmentioning

confidence: 99%

Cost Implications of Formulary Decisions on Oral Anticoagulants in Nonvalvular Atrial Fibrillation

Biskupiak¹,

Ghate²,

Jiao³

et al. 2013

JMCP

View full text Add to dashboard Cite

show abstract

“…We presumed that it is most appropriate to use the Medicare allowable payment as our patient population predominantly has Medicare coverage. Additionally, we assumed that all patients spend $10.78 round trip on transportation to clinic for their visits based on survey results [11]. Finally, we assumed that all of our patients miss 2 hours of productive activity for each clinic visit to estimate the productivity cost.…”

Section: Discussionmentioning

confidence: 99%

“…The transportation and productivity cost were estimated through a survey of 60 patients [11]. Based on those results, we estimated $10.78 as the round-trip cost for a clinic visit.…”

Section: Cost Analysismentioning

confidence: 99%

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Bridging for an isolated subtherapeutic INR: an evaluation of clinical practice patterns, outcomes, and costs from an anticoagulation clinic

Hwang

Taylor

Sharma

et al. 2011

J Thromb Thrombolysis

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No formal recommendations support bridging patients taking warfarin for a subtherapeutic international normalized ratio (INR). This study aimed to: (1) characterize practices at one anticoagulation clinic, (2) evaluate adverse events, and (3) compare cost of bridging versus withholding bridging for subtherapeutic INR. A retrospective chart review of 320 patients having 546 isolated subtherapeutic INR episodes included patients with an INR below their therapeutic range, preceded by two INRs within or above range. Bridged episodes required more frequent follow-up visits to achieve therapeutic INR (2.5 ± 1.0 vs. 2.2 ± 0.6; P = 0.097), but fewer days until the INR returned to therapeutic range (6.8 ± 5.0 vs. 18.9 ± 16.0; P < 0.0001). The strongest predictor of bridging was the magnitude the INR fell below the therapeutic range, where those with a severely-low INR were 30-fold more likely to be bridged (P < 0.0001), and moderately-low INR episodes were 6-fold more likely to be bridged compared with mildly-low INR (P < 0.0001). Those at high thromboembolic risk were more likely to be bridged than at low-risk (OR 3.39 [1.50-7.68]; P = 0.0034). Increasing age reduced the likelihood of being bridged (OR 0.97 [0.95-0.99]; P = 0.0118). Adverse events were infrequent in both the bridged and non-bridged; thrombosis (2.0 vs. 0.7%), major bleeding (2.0 vs. 1.3%), minor bleeding (4.1 vs. 3.1%) and bruising (18.4 vs. 3.6%). Incremental cost difference of bridging was significantly greater for total cost ($967.13) and its components, direct medical ($951.32), transportation ($2.73) and productivity cost ($13.08). It is unclear if bridging for an isolated subtherapeutic INR reduces thrombosis risk, but it is associated with higher costs.

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Association between transportation barriers and anticoagulation control among an inner‐city, low‐income population: A prospective observational cohort study

Yan

Naveed

Alobaidi

et al. 2021

Research and Practice in Thrombosis and Haemostasis

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Transportation Cost of Anticoagulation Clinic Visits in an Urban Setting

Cited by 14 publications

References 9 publications

Cost Implications of Formulary Decisions on Oral Anticoagulants in Nonvalvular Atrial Fibrillation

Cost Implications of Formulary Decisions on Oral Anticoagulants in Nonvalvular Atrial Fibrillation

Bridging for an isolated subtherapeutic INR: an evaluation of clinical practice patterns, outcomes, and costs from an anticoagulation clinic

Association between transportation barriers and anticoagulation control among an inner‐city, low‐income population: A prospective observational cohort study

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