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Electronic letters to:

Research:
Dean A. Regier, Rubina Sunderji, Larry D. Lynd, Kenneth Gin, and Carlo A. Marra
Cost-effectiveness of self-managed versus physician-managed oral anticoagulation therapy
CMAJ 2006; 174: 1847-1852 [Abstract] [Full text] [PDF]
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Electronic letters published:

[Read eLetter] Will this economic evaluation be good enough for policy makers to be impressed?
Jeevan P Marasinghe   (29 June 2006)

Will this economic evaluation be good enough for policy makers to be impressed? 29 June 2006
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Jeevan P Marasinghe
Registrar,Professorial Obstetrics and Gynaecology,faculty of medicine ,Peradeniya,Sri Lanka.

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Re: Will this economic evaluation be good enough for policy makers to be impressed?

jeevanmarasinghe{at}yahoo.com Jeevan P Marasinghe

Dear Sir, Dean A et al have been successful in demonstrating a fewer thrombotic events, fewer major hemorrhagic events, fever deaths and a substantial cost effectiveness in patient self monitoring and patient self management of oral anticoagulation therapy as compared to physician managed anti coagulation therapy .It is doubtless that this has proven to be cost effective and reduces a major burden in the health care system (1) (2) by several clinical trials.

But the biggest hurdle is that it may not be applicable to all clinical population.Infact it has been shown that these models are for a significant minority of patients (4).Special attention has to be paid on patient selection, training on dosage adjustment and clinical supervision. The ability to understand concept of oral anticoagulation therapy and the clinical importance and risks of over treatment may not be generalized to whole population. These initial works on patient selection, training, and product maintenance have to be considered and had to be included the methodology and it may not be economically that attractive at the end. So the genaralizability to a larger population and cost effectiveness of this programme remains to be demonstrated.

Jeevan P Marasinghe.Professorial Obstetrics and Gynecology unit, Teaching Hospital, Peradeniya.

Amarasinghe AAW.MD.McDonough, Georgia, USA.

References

(1)McCahon D et al SMART: self management of anticoagulation, a randomized trial.BMC Fam Prac 2003 Sep 18; 4:11.

(2)Ansell JE et al .Long term patient self management of oral anticoagulation. Arch Intern Med 1995 Nov 13; 155(20):2185-9.

(3)Sunderji R et al.Patient self management of oral anticoagulation: a review. Can J Cardiol 2003 Jul; 19(8):931-5.

(4)Fitzmaurice DA.An evidence based review and guidelines for patient self testing and management of oral anticoagulation.Br J Haematol.2006 Jan; 132(1):118.

Conflict of Interest:

None declared