Use of point-of-care devices in patients with oral anticoagulation : a Health Technology Assessment

Gailly J, Gerkens S, Van Den Bruel A, Devriese S, Obyn C,Cleemput I
Record ID 32010001232
Authors' recommendations: Compared with laboratory INR testing, the testing of INR with point-of-care devices is a good option for patients with long term anticoagulation with vitamine K antagonists. Globally, POC testings increase patient’ satisfaction, lead to less thrombo-embolic events and less all cause mortality but have no impact on the number of major bleeding events.Four potential organisation models are compared: two at patient level (PSM and PST) and two at health professional level (POC by GP and POC in AC). PSM and PST strategies need patient selection and training. In specific situations (such as child), PSM or PST may be done by a close relative. External quality control is needed for POC devices in each strategy.• Patient self monitoring (PSM) is the first choice organisation at the patient level with respect to clinical outcomes (less thrombo-embolic events and less all causes mortality), and also at the payer level, because it is the dominant strategy with the highest cost-savings.• Compared with PSM, patient self-testing (PST) is the second choice at patient level. PST improves thrombo-embolic events but not all causes mortality. For the payer perspective the cost-savings are also lower and depend of the number of INR tests and essentially of the number of GP visits maintained.• Considering the use of POC by GP, there is not evidence that it improves (or damages) the clinical outcomes of patients compared with usual care. From the payer perspective, such strategy is cost saving compared with the same number of laboratory INR testing. The increase of the number of POC tests goes however always with an increase of the number of GP contacts and this strategy is not yet cost-saving in a scenario of 26 tests/ patient/ year.• Considering the use of POC devices by health professionals in anticoagulation clinics, there is also not evidence that it improves (or damages) the clinical outcomes of patients compared with usual care. In this strategy, the incremental costs depends on several parameters: the number of opening hours of the AC, the number of patients followed, the number of INR tests per patient and per year, and especially the number of remaining GP consultations or visits.In conclusion, for patients who have the willingness and the ability to do it, PSM is the best strategy. Patients scheduled to long term oral anticoagulation (or close relative of such patients) should be encouraged and trained for PSM. For others patients who need help for testing and/or management, several POC strategies (PST, POC at GP, and POC at AC) were available, near usual care with laboratory INR testing, with advantages and limits described in this report.
Project Status: Completed
Year Published: 2009
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Belgium
MeSH Terms
  • Administration, Oral
  • Point-of-Care Systems
  • Self Care
Organisation Name: Belgian Health Care Knowledge Centre
Contact Address: Administrative Centre Botanique, Doorbuilding (10th floor), Boulevard du Jardin Botanique 55, B-1000 Brussels, Belgium tel: +32 2 287 33 88 fax: +32 2 287 33 85
Contact Name:
Contact Email:
Copyright: Belgian Health Care Knowledge Centre (KCE)
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.