Original Title: Autocontrol domiciliario del tratamiento anticoagulante oral con antagonistas de la vitamina K: evaluación de aceptabilidad y coste-efectividad

Authors' objectives: 1. To identify and synthesise expectations, preferences, barriers and facilitators as well as levels of satisfaction and experiences among patients and health professionals regarding home self-monitoring programmes for oral anticoagulant therapy (OAT) with vitamin K antagonists (VKAs) involving patient self-testing and/or self-management (PST/PSM). 2. To assess the cost-effectiveness of home self-monitoring programmes for OAT with VKAs, using PST/PSM.

Authors' results and conclusions: A total of 17 studies published between 2015 and 2025 were included. These analysed patients’ and/or health professionals’ experiences with and acceptance and perception of self-monitoring programmes for OAT with VKAs. The majority were observational and qualitative studies, mostly carried out in Europe, and included adults on long-term treatment with warfarin or acenocoumarol. From the perspective of patients, the available evidence, which is of moderate overall quality, shows a high level of acceptability of INR selfmonitoring (PST/PSM). Research shows consistent benefits in terms of greater self-independence and self-efficacy, a lower healthcare burden than with conventional monitoring, and greater self-perceived quality of life, provided structured training and continuous clinical and technical support are available. The main barriers identified were related to difficulties in the use of and access to technological devices, an initial lack of confidence in self-monitoring, and equity factors, such as the cost of devices and digital and health literacy, especially among older people. From the perspective of healthcare professionals, organizational and training barriers were identified that are critical for the safe and sustainable implementation of self-monitoring programmes for OAT with VKAs, including funding, standardized protocols, and healthcare coordination. The study that analysed both perspectives highlights the need for a balance between patients´ independence and proper supervision by health professionals, and for structured pathways of support and follow-up. The economic evaluation studies indicate that home self-monitoring of INR, through PST/PSM, in adult patients receiving OAT with VKAs, is associated with greater clinical effectiveness, as measured in quality-adjusted life years, than conventional monitoring in healthcare settings. In three out of the four studies analysed, self-monitoring showed positive incremental effectiveness as well as a moderate increase in costs, while the other study found it to be the dominant intervention, with greater effectiveness and cost savings. Deterministic univariate sensitivity analyses indicated that the results were robust to reasonable variations in the parameters, with the relative risk of thromboembolic events and the frequency of the tests identified being key factors. Finally, probabilistic sensitivity analysis indicated that the likelihood of the intervention being cost-effective ranged from 71% to 80%. CONCLUSIONS - – A total of 17 studies were included (2015–2025), mostly observational and qualitative in nature, analysing experiences with and acceptance of PST/PSM of OAT with VKAs in real clinical practice.– PST/PSM is in general well accepted by patients, and associated with a positive experience, especially in terms of convenience, independence and satisfaction.– PST/PSM programmes help to reduce treatment burden, especially in terms of fewer patient journeys and a better integration of INR monitoring into daily life, with perceived improvements in quality of life.– Greater independence, control and self-efficacy are the primary advantages of PST/PSM, although the level of responsibility assumed varies between patients and requires individualised approaches.– The perception of safety depends on structured training and access to professional support, especially in the initial stages of the programme. – Support technologies are generally well accepted when they are intuitive and integrated into care pathways, although there still are technical, digital and accessibility barriers– Patient self-monitoring is not suitable for all patients and should be introduced gradually and not in all cases.– Significant barriers remain in terms of equity and organisation, especially regarding costs, funding, protocols and healthcare coordination.– Although the methodological quality is predominantly moderate, the results are consistent and relevant for guiding the implementation of PST/PSM in the Spanish National Health System.– The available evidence indicates that home self-monitoring of INR, through PST/PSM in patients on OAT with VKAs, may be a costeffective option compared to conventional monitoring of INR in primary or specialised healthcare settings or anticoagulation clinics.

Authors' methods: A systematic review was performed in accordance with the methodological principles of rapid reviews in health technology assessment. The objective was to identify and synthesise key evidence to support decision-making in the context of the Spanish National Health System, by separately addressing people’s experiences with and acceptance of home self-monitoring programmes for OAT with VKAs and their economic implications. A structured literature search was carried out in databases that include systematic reviews and primary studies (HTA International Database, Cochrane Library, MEDLINE, Embase, CINAHL, PsycINFO and CEA Registry). This was complemented by manual searching and journal alert systems. The review included studies published in the last ten years, in English or Spanish. For the analysis of experiences and acceptability, studies were selected that assessed the perceptions, satisfaction, barriers and facilitators of home PST/PSM for OAT with VKAs from the perspective of patients and/or health professionals. Additionally, economic evaluation studies comparing the costeffectiveness of these programmes with that of conventional monitoring were included. The selection was conducted in accordance with the Population, Intervention, Comparison, and Outcome (PICO) criteria, and the process was documented using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. The methodological quality was assessed using critical appraisal forms tailored to the design of each study and, in the case of the qualitative studies, supported by the Critical Appraisal Skills Programme (CASP) tool. The data were extracted using standardised forms and summarised using a structured narrative synthesis, bringing together both qualitative and quantitative results.

Project Status: Completed

Year Published: 2026

URL for published report: https://www.euskadi.eus/contenidos/informacion/osteba_publicacion/es_def/adjuntos/Tratamiento_anticoagulante_oral.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government</p>