Direct Medical Costs of Venous Thromboembolism and Subsequent Hospital Readmission Rates: An Administrative Claims Analysis From 30 Managed Care Organizations

Abstract

JMCP Journal of Managed Care Pharmacy 475V enous thromboembolism (VTE) is ac ommon medical condition comprising deep vein thrombosis (DVT) and pulmonarye mbolism (PE). VTE is of particular importance in the hospital setting since moret han half the cases of VTE areaccounted for by institutionalization, with 24% of the cases attributable to hospitalization for surgery. 1 In the absence of prophylaxis, the incidence of objectively confirmed, hospital-acquired DVT ranges from 10% to 40% in the medical and general surgical population to as high as 40% to 60% in patients who have undergone orthopedic surgery. 2 Furthermore, What is already known about this subject•VTE is acommon medical condition of particular importance in the hospital setting. In patients with major surgery, the diagnosis and treatment of an initial VTE event poses as ignificant economic burden to health careinthe United States.•The diagnosis and treatment of the initial VTE event incurs costs, but the VTE recurrences and long-term complications of VTE create additional costs. It was found previously that 1i n4 patients who experienced aV TE event during the incident hospital stay had additional VTE-related events requiring hospitalization in the 21 months of follow-up. These events incurred an average health plan cost of $14,957 per event, or $2,101 per patient per year. What this study adds•T he total annual health carec ost for aV TE ranged from $7,594 to $16,644, depending on the type of event and whether it was a primaryo rs econdaryd iagnosis. The hospital readmission rates of DVT or PE within 12 months were5 .3% for primarya nd 14.3% for secondarydiagnoses.•T he recurrent DVT event was associated with 21% greater cost compared with the initial DVT event, but therew as no difference in cost for the recurrent PE event compared with the initial PE event.•T he use of health plan total medical costs, including outpatient medical and pharmacy in this study,r esulted in higher total costs compared with previous studies that used hospital inpatient costs.BACKGROUND: Venous thromboembolism (VTE) is acommon medical condition manifested as deep vein thrombosis (DVT) or pulmonaryembolism (PE). Few data exist on the total economic burden of DVT and PE.OBJECTIVE: To (1) quantify the economic burden of DVT and PE in direct medical costs and utilization and (2) determine the rates of hospital readmission for DVT and PE.METHODS: Hospital claims containing DVT or PE as aprimaryorsecondary discharge diagnosis during the period February1998 through June 2004 were identified by retrospective analysis using the Integrated Health CareInformation Services (IHCIS) National Managed CareDatabase.For the cost analysis, we included patients that had been enrolled in ahealth careplan for aminimum of 30 days prior to and 365 days following the DVT or PE hospitalization. For the readmission analysis, patients wererequired to have aminimum length of stay of 3days and apreenrollment of 365 days. We quantified the cost burden to the health plan by examining annual DVT-...

Incremental Health Care Resource Utilization and Economic Burden of Venous Thromboembolism Recurrence from a U.S. Payer Perspective

“…15 VTE recurrence rates in the commercial and Medicare populations were similar to the 14.3% rate of hospital readmission for VTE among patients with VTE as a secondary diagnosis reported by Spyropoulos and Lin. 10 Other less recent studies have reported VTE recurrence rates to range between 7.0% and 14.0%. 11 Even in patients who only experienced an initial event with no recurrence, VTE-related care and associated payments (commercial: $15,123 per patient per year; Medicare: $10,399 per patient per year) were substantial.…”

“…9 The health care and economic burdens of VTE are not only related to diagnosis and treatment of the initial event, but also to VTE recurrence. [10][11][12] Spyropoulos and Lin (2007) reported that hospital readmission rates of hospitalized VTE patients were between 5.3% and 14.3% by 1 year. 10 It is important to better understand the overall health care and economic burdens of recurrent VTE among both inpatient-and outpatienttreated VTE patients and to define populations at high risk for VTE recurrence in order to potentially improve the quality of care for VTE patients.…”

“…[10][11][12] Spyropoulos and Lin (2007) reported that hospital readmission rates of hospitalized VTE patients were between 5.3% and 14.3% by 1 year. 10 It is important to better understand the overall health care and economic burdens of recurrent VTE among both inpatient-and outpatienttreated VTE patients and to define populations at high risk for VTE recurrence in order to potentially improve the quality of care for VTE patients. 6,7 To that end, this study's purpose was to evaluate the rate and predictors of VTE recurrences among both inpatient-and outpatient-treated VTE patients and determine the incremental burden of health care resource utilization and costs among patients with VTE recurrence who have commercial or Medicare insurance coverage in the United States.…”

Emergency department visits by patients with venous thromboembolism, 1998-2009

“…The occurrence of VTE also results in substantial health care costs. The annual direct medical cost associated with a case of VTE ranged from $7,600 to $16,600, depending on the type of event and diagnosis, according to one study [5] .…”

Is Adherence to the American College of Chest Physicians Recommended Anticoagulation Treatment Duration Associated With Different Outcomes Among Patients With Venous Thromboembolism?

“…5,6 The average total annual VTE-related health-care payment per patient is estimated to be over US$30 000, and the annual total health-care cost associated with VTE ranges from US$7.5 to US$39.5 billion. [7][8][9] The length of oral anticoagulant (OAC) therapy to prevent thrombosis recurrence is based on recommendations from the American College of Chest Physicians (ACCP) clinical practice guidelines. [10][11][12] The minimum duration of anticoagulant (AC) therapy recommended by the ACCP guidelines is dependent upon patient risk profiles.…”