Safety, quality, and cost-effectiveness of telemedicine-based management of vitamin K antagonists in a public cardiology center

Background Vitamin K antagonist (VKA) therapy requires frequent monitoring. Although telemedicine has expanded, evidence on its effectiveness in public health systems of developing countries remains limited. We evaluated the safety, quality of anticoagulation control, and cost-effectiveness of telemedicine-based versus in-person follow-up in a Brazilian tertiary public center. Methods This retrospective observational study at a Brazilian tertiary university hospital compared an in-person phase with the telemedicine phase initiated in April 2020. Outcomes were time in therapeutic range (TTR), all-cause and anticoagulation-related mortality, and direct healthcare costs. TTR was compared within patients ( n = 661 followed regularly in both phases); mortality was compared as phase-specific annualized rates among all patients followed in each phase (1313 in-person; 1086 telemedicine). Results Median TTR did not differ between the in-person and telemedicine phases (58% vs. 60%; p = .35). Annualized all-cause mortality (69 vs. 77 deaths per 1000 person-years; p = .43) and anticoagulation-related mortality (13 vs. 11 per 1000 person-years; p = .61) were also comparable. Cost-minimization analysis showed that telemedicine reduced annual direct expenditures by 10% (USD 4473; 95% CI: 2904–6030). Discussion Telemedicine-based monitoring for patients on VKAs is as safe and clinically effective as traditional in-person care. Furthermore, telemedicine offers lower direct costs, proving to be a viable alternative to optimize resource allocation and enhance efficiency within the public health system.