A geospatial model to determine the spatial cost-efficiency of anticoagulation drug therapy: Patients’ perspective

  • Mikko Pyykönen | mikko.pyykonen@uef.fi Department of Geographical and Historical Studies, University of Eastern Finland, Joensuu, Finland.
  • Aapeli Leminen Department of Geographical and Historical Studies, University of Eastern Finland, Joensuu, Finland.
  • Juho Tynkkynen Faculty of Medicine and Health Technology, Tampere University, Tampere; Department of Radiology, Kanta-Häme Central Hospital, Hämeenlinna, Finland.
  • Markku Tykkyläinen Department of Geographical and Historical Studies, University of Eastern Finland, Joensuu, Finland.
  • Tiina Laatikainen Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio; Joint Municipal Authority for North Karelia Social and Health Services, Joensuu; Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.

Abstract

Most atrial fibrillation (AF) patients need anticoagulation management to reduce the risk of thromboembolic events and stroke. Currently, two major drug therapies are available: warfarin and direct oral anticoagulant (DOAC). This study examined the spatial costs of these therapies and derived the least-cost market areas for both therapies in the study area. The concepts of spatial costs and the principles of forming market areas were used as theoretical starting points, and the patients’ travel, time-loss, and medication cost parameters combined with geographical information systems methods were incorporated into the geospatial model. Results showed that for AF patients who live near the international normalized ratio (INR) monitoring sample collection point and have less than 15 annual INR monitoring visits, warfarin therapy resulted in the lowest cost regardless of patient’s travel mode and their assumed working or retirement status. If the AF patient needs more frequent INR monitoring visits or lives farther from the nearest sample collection point, DOAC would be the least costly option. The modelled results reveal the variety and importance of patients’ cost of time loss and travel costs when a physician selects the appropriate anticoagulation therapy.

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Published
2019-11-06
Section
Original Articles
Keywords:
Geographical information systems, Atrial fibrillation, Least-cost therapy, Market areas, Network analysis
Statistics
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How to Cite
Pyykönen, M., Leminen, A., Tynkkynen, J., Tykkyläinen, M., & Laatikainen, T. (2019). A geospatial model to determine the spatial cost-efficiency of anticoagulation drug therapy: Patients’ perspective. Geospatial Health, 14(2). https://doi.org/10.4081/gh.2019.809