The prevalence of pulmonary embolism (PE), PE mortality and treatment-associated costs for the years 2000 to 2006 were analysed using a statutory health insurance sample of AOK Hesse/KV Hesse, which contained information for an 18.75% random sample of 1.9 million persons insured with the AOK Hesse. Within the sample a PE diagnosis was accepted as valid if it was documented as the main discharge diagnosis or as an additional hospital diagnosis during hospitalization and if at least one of the following criteria was met: prescription of oral anticoagulants or heparins, PE documented for at least two quarterly periods or documented in only one quarter for patients who died within 28 days after hospital discharge. The economic burden from the perspective of the insurance fund was assessed by an analysis of resource consumption (direct costs) and by a matched pair analysis with controls without PE to estimate excess costs. A 99% winsorization of each cost category was performed to control for extreme outlying values. The prevalence of PE as the main discharge diagnosis and an additional hospital diagnosis varied from 55.3 to 71.7 per 100,000 insurants in the years 2000 to 2006. Insurants aged 80 years and more had a prevalence of 406.9 per 100,000 (year 2006). From 2001 to 2003 the in-hospital mortality rate ranged from 20.4% to 24.9% and decreased to 14% in 2006. A total of 85% of all patients with PE who survived the first year had at least one prescription of vitamin K antagonists. For patients who survived the first year, treatment costs exceeded € 20,000, with an estimation of additional costs of € 5816 for men and € 8962 for women in the matched-pair analysis. Owing to high in-hospital costs, the overall cost of treatment was highest for patients younger than 60 years. In conclusion, the prevalence rate of PE in Germany is comparable to international data. Treatment costs within the first year after hospital discharge are high, and there is a need to clarify the settings associated with PE in Germany with its high rate of prophylaxis.

With the introduction of diagnosis-related groups (DRG) for reimbursement in 2003, detailed description of the prevalence of pulmonary embolism in hospitalized patients in Germany was possible for the first time. Thus, we analysed the incidence of pulmonary embolism in hospitalized young people and looked for a sex-specific difference in comorbidity. Detailed lists of all pulmonary embolism coded as I26 in hospitalized patients aged 10-40 years in 2005, 2006 and 2007 were provided by the Federal Statistical Office. Beginning at the age of 12-13 years females have higher numbers of pulmonary embolism and DVT documented as principal diagnosis compared with men. This sex-specific difference disappears at the ages of 32-33 years. The total numbers of pulmonary embolism distinguishing males and females within this 20 years life period is low and varied from 318-463 in the 3 years. The sex-specific difference is highest in the group of 16 to 17-year-old people (ratio of females to males varies from 3 to 5 in 2005-2007). Specific patterns of comorbidities associated with the higher numbers of pulmonary embolism in younger females could not be detected. Pregnancies account for a maximum of 73 in 2007, which reached only less than one-fifth of the absolute difference in pulmonary embolism between males and females in the single years. The presented data derived from the most reliable data basis for the estimation of pulmonary embolism in Germany show that compared with males there is a sharp increase in hospitalization for pulmonary embolism in females beginning at the age of 12-13 years. Males catch up by the ages of 32-33 year.

Elastic compression stockings (ECS) as a physical tool for prevention of deep vein thrombosis were introduced in the 70 s and 80 s of the last century and they are still used today. Two recent studies have arisen a discussion regarding the benefit of the combined used of ECS and pharmaceutical prophylaxis over pharmaceutical prophylaxis alone. One study on patients receiving total hip replacement and one study on patients suffering from stroke did not show an advantage of the combination. In addition the German, the American and the British Guidelines do not give precise and mandatory indication for the use of ECS in addition to pharmaceutical prophylaxis. They describe the lack of adequate data and the problems in patient care using ECS. Thus, due to the lack of evidence and the possibility of adverse events a routine use of ECS is not justified. The only generally accepted indication for ECS is in patients with moderate and high risk for venous thromboembolism when pharmaceutical prophylaxis is not possible.

The presented data show higher hospitalization rates for females in the age group 10 to 39 years for different venous thrombosis but not for MI and ES.

No abstract