{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T12:03:49Z","timestamp":1780920229368,"version":"3.54.1"},"reference-count":67,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patient self\u2010management (PSM) is a warfarin management strategy that allows patients to independently adjust their doses. PSM significantly reduces thrombosis events and has been widely implemented internationally. However, adoption of PSM is limited in the United States. This study estimated the cost\u2010effectiveness of PSM compared with available strategies, including anticoagulation management services (AMS) and usual care (UC) for patients with non\u2010valvular atrial fibrillation (NVAF) aged 70\u2009years and older in the United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cost\u2010effectiveness analysis was performed to estimate lifetime costs and outcomes of PSM compared with AMS and UC employing a Markov model. The model simulated a 70\u2010year\u2010old with NVAF over the patient's lifetime from modified societal and payer perspectives. Transition probabilities were derived from annual event rates reported in the ARISTOTLE trial. Comparative efficacy and safety among the interventions were obtained from a network meta\u2010analysis. Costs, presented in 2024 US dollars (USD), and utility data were obtained from data sources in the United States. A discount rate of 3% was applied for future costs and outcomes. One\u2010way sensitivity analysis and probabilistic sensitivity analysis were performed to assess the robustness of the findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The lifetime costs from the modified societal perspective were $137,509 USD for UC, $129,216 USD for AMS, and $76,515 USD for PSM. Discounted quality\u2010adjusted life years (QALYs) were estimated to be 8.27 for UC, 8.30 for AMS, and 8.47 for PSM. Additionally, PSM substantially reduced stroke incidence compared with AMS and UC, contributing to lower costs and greater QALYs. Probabilistic sensitivity analysis showed that PSM appeared to be the most cost\u2010effective at any willingness\u2010to\u2010pay threshold.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PSM is the most cost\u2010effective strategy for managing warfarin in the target population at any willingness\u2010to\u2010pay threshold. Implementation of PSM in the US health care setting should be considered.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/phar.70154","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T06:29:21Z","timestamp":1778826561000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost\u2010Effectiveness Analysis of Patient Self\u2010Management of Warfarin Among Patients With Non\u2010Valvular Atrial Fibrillation"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7500-8416","authenticated-orcid":false,"given":"Warittakorn","family":"Kategeaw","sequence":"first","affiliation":[{"name":"Department of Pharmacotherapy, College of Pharmacy University of Utah  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3930-8358","authenticated-orcid":false,"given":"Daniel M.","family":"Witt","sequence":"additional","affiliation":[{"name":"Department of Pharmacotherapy, College of Pharmacy University of Utah  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan B.","family":"King","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, Spencer Fox Eccles School of Medicine University of Utah  Salt Lake City Utah USA"},{"name":"Institute for Health Research Kaiser Permanente Colorado  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5006-9394","authenticated-orcid":false,"given":"Daniel C.","family":"Malone","sequence":"additional","affiliation":[{"name":"Department of Pharmacotherapy, College of Pharmacy University of Utah  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4572-8794","authenticated-orcid":false,"given":"Nathorn","family":"Chaiyakunapruk","sequence":"additional","affiliation":[{"name":"Department of Pharmacotherapy, College of Pharmacy University of Utah  Salt Lake City Utah USA"},{"name":"IDEAS Center Veterans Affairs Salt Lake City Healthcare System  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102125.2006.02806.x"},{"key":"e_1_2_10_3_1","volume-title":"Warfarin. StatPearls","author":"Patel S.","year":"2023"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u2010121\u20109\u2010199411010\u201000009"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.11\u20102292"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.7812\/tpp\/14\u2010246"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.281.2.182"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD003839.pub3"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2024.102712"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2018.07.040"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2018024893"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0095761"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12872\u2010019\u20101168\u20102"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12959\u2010025\u201000694\u2010z"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11239\u2010023\u201002877\u20109"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/jac5.1879"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/phar.1139"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2021.11.1351"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2019.11.012"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40273\u2010018\u20100741\u20103"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538\u20107836.2005.01204.x"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1107039"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejro.2023.100527"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.0000012515.66889.24"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u2010120\u201011\u2010199406010\u201000001"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2012.05.011"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1474\u20104422(12)70092\u20103"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu006"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u2010154\u20101\u2010201101040\u201000289"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.2105\/ajph.88.3.395"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1023\/a:1011460631369"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0735\u20101097(98)00297\u20106"},{"issue":"1","key":"e_1_2_10_33_1","first-page":"1","article-title":"United States Life Tables, 2020","volume":"71","author":"Arias E.","year":"2022","journal-title":"National Vital Statistics Reports"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1177\/0272989x06290495"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.111.000402"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000172050.67085.4f"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.2165\/00019053\u2010200624100\u201000009"},{"key":"e_1_2_10_38_1","unstructured":"\u201cMicromedex RED BOOK \u201d(2023)."},{"key":"e_1_2_10_39_1","unstructured":"Centers for Medicare and Medicaid Sevices \u201cClinical Laboratory Fee Schedule \u201d(2023) https:\/\/www.cms.gov\/medicare\/payment\/fee\u2010schedules\/clinical\u2010laboratory\u2010fee\u2010schedule\u2010clfs."},{"key":"e_1_2_10_40_1","unstructured":"Centers for Medicare and Medicaid Sevices \u201cPhysician Fee Schedule \u201d(2023) https:\/\/www.cms.gov\/medicare\/physician\u2010fee\u2010schedule\/search."},{"key":"e_1_2_10_41_1","unstructured":"U.S. Bureau of Labor Statistics \u201cMay 2023 National Occupational Employment and Wage Estimates \u201d(2023) https:\/\/www.bls.gov\/oes\/curreFnt\/oes_nat.htm."},{"key":"e_1_2_10_42_1","unstructured":"\u201cMedical Device Depot \u201d(2023) https:\/\/www.medicaldevicedepot.com."},{"key":"e_1_2_10_43_1","unstructured":"\u201cMedical Rite \u201d(2023) https:\/\/medicalrite.com\/."},{"key":"e_1_2_10_44_1","unstructured":"\u201cMedical Supply Pros \u201d(2023) https:\/\/medicalsupplypros.com\/."},{"key":"e_1_2_10_45_1","unstructured":"Agency for Healthcare Research and Quality \u201cHCUPnet: Inpatient Stays National \u201d(2023) https:\/\/datatools.ahrq.gov\/hcupnet\/."},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2020.117181"},{"key":"e_1_2_10_47_1","unstructured":"A. J.WeissandM.Roemer \u201cMethods for Calculating Patient Travel Distance to Hospital in HCUP Data \u201d(2021)."},{"key":"e_1_2_10_48_1","unstructured":"Internal Revenue Service \u201cIRS Issues Standard Mileage Rates for 2022 \u201d(2023) https:\/\/www.irs.gov\/newsroom\/irs\u2010issues\u2010standard\u2010mileage\u2010rates\u2010for\u20102022."},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.2147\/cia.S91123"},{"key":"e_1_2_10_50_1","unstructured":"U.S. Bureau of Labor Statistics \u201cOccupational Employment and Wage Statistics+++ \u201d(2026) https:\/\/data.bls.gov\/oes\/#\/occInd\/One%20occupation%20for%20multiple%20industries."},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.2165\/00019053\u2010200321030\u201000004"},{"key":"e_1_2_10_52_1","unstructured":"U.S. Bureau of Labor Statistics \u201cCivilian Labor Force Participation Rate by Age Sex Race and Ethnicity \u201d(2025)."},{"key":"e_1_2_10_53_1","unstructured":"U.S. Bureau of Labor Statistics \u201cLabor Force Share by Age Group \u201d(2026) https:\/\/www.bls.gov\/emp\/graphics\/labor\u2010force\u2010share\u2010by\u2010age\u2010group.htm."},{"key":"e_1_2_10_54_1","unstructured":"U.S. Bureau of Labor Statistics \u201cConsumer Price Index (CPI) Databases \u201d(2023) https:\/\/www.bls.gov\/cpi\/data.htm."},{"key":"e_1_2_10_55_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.12195"},{"key":"e_1_2_10_56_1","volume-title":"Methods for the Economic Evaluation of Health Care Programmes","author":"Drummond M. F.","year":"2015"},{"key":"e_1_2_10_57_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12154984"},{"key":"e_1_2_10_58_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.33222"},{"key":"e_1_2_10_59_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11236984"},{"key":"e_1_2_10_60_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2025.31.4.366"},{"key":"e_1_2_10_61_1","doi-asserted-by":"publisher","DOI":"10.1007\/s41669\u2010022\u201000337\u20103"},{"key":"e_1_2_10_62_1","doi-asserted-by":"publisher","DOI":"10.1161\/circoutcomes.113.000661"},{"key":"e_1_2_10_63_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2025.07.072"},{"key":"e_1_2_10_64_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12325\u2010023\u201002620\u2010z"},{"key":"e_1_2_10_65_1","unstructured":"G. A.Puckrein \u201cWhen Cost Control Ignores the Data: Why the IRA Fails to Address Cardiovascular Disparities \u201d(2026) https:\/\/www.healthaffairs.org\/sponsored\u2010content\/when\u2010cost\u2010control\u2010ignores\u2010the\u2010data\u2010why\u2010the\u2010ira\u2010fails\u2010to\u2010address\u2010cardiovascular\u2010disparities."},{"key":"e_1_2_10_66_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2026.2627"},{"key":"e_1_2_10_67_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102019\u2010034778"},{"key":"e_1_2_10_68_1","doi-asserted-by":"publisher","DOI":"10.1161\/circoutcomes.119.005969"}],"container-title":["Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/phar.70154","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/phar.70154","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/phar.70154","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T11:24:30Z","timestamp":1780917870000},"score":1,"resource":{"primary":{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/10.1002\/phar.70154"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,14]]},"references-count":67,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1002\/phar.70154"],"URL":"https:\/\/doi.org\/10.1002\/phar.70154","archive":["Portico"],"relation":{},"ISSN":["0277-0008","1875-9114"],"issn-type":[{"value":"0277-0008","type":"print"},{"value":"1875-9114","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,14]]},"assertion":[{"value":"2025-12-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70154"}}