Patient and healthcare provider burden due to conventional measurement of the international normalized ratio: From a multi-dimensional perspective

Objectives: In this study, we aimed to investigate the healthcare burden associated with hospital visits for international normalized ratio (INR) measurement from a multi-dimensional perspective. Patients and methods: A total of 415 patients (198 males, 217 females; mean age: 54±12.7 years; range, 14 to 84 years) who were admitted to the cardiovascular surgery (CVS) outpatient clinic between March 2015 and June 2015 were included. The burden of INR measurement was assessed in two main categories: social and clinical. Data including educational status, occupational status and accompanying persons, indications for warfarin use, history of warfarin-related complications, expenses made by the patient and the accompanying persons, and the time spent were recorded. Results: A total of 1,259 laboratory entries were found for the overall study population. Of these entries, 99.4% were only for INR measurements. An INR outside the target therapeutic range (TTR) was detected in 53.7% of the patients. Among all patients attending to the CVS outpatient clinic during the study, the sole reason for attendance was the INR measurement in 23%. The rate of complications requiring intervention was 2.1%. The daily clinical cost per patient was $22.14, the social monetary cost was $9.77, and the total cost was $31.91. Conclusion: Conventional INR measurements have a significant social and economic impact on patients and are associated with significantly increased workload and loss of resources from the perspective of the healthcare provider.