Effectiveness and Economic Impact Associated With a Program for Outpatient Management of Acute Deep Vein Thrombosis in a Group Model Health Maintenance Organization

Tillman, Donald J.; Charland, Scott L.; Witt, Daniel M.

doi:10.1001/archinte.160.19.2926

Cited by 80 publications

(51 citation statements)

References 19 publications

(27 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These studies focused on a wide variety of settings and management strategies, such as prospective outpatient management of recurrent thromboembolism events (100, 125, and 107 patients) [29][30][31] ; randomized, multicenter trials 16,32,33 ; decision modeling approaches 16,18 ; and home-oriented pharmacy management. 34 Two observational studies focused on detailing DVT costs of care from the MCO perspective over the first 90 days: (1) a prospective study inside a group-model HMO 35 and (2) a retrospective study conducted in a staff-model HMO. 36 Spyropoulos et al, in a retrospective staff-model HMO study, followed 129 patients with DVT and reported an average cost of care for the first 90 days of between $9,347 and $11,930, depending on whether the initial treatment consisted of LMWH or UFH.…”

Section: Discussionmentioning

confidence: 99%

“…36 Tillman et al followed 391 patients with DVT in a group-model HMO, all acutely treated with LMWH, and reported an estimated cost of $4,695 per initial hospitalization. 35 One retrospective observational study conducted in a realworld setting detailed the cost of VTE care by using discharge data from 6 states. 15 The study had a payer mix of 56.0% Medicare, 22.5% managed care, and 21.5% not reported.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Longitudinal Evaluation of Health Plan Cost per Venous Thromboembolism or Bleed Event in Patients With a Prior Venous Thromboembolism Event During Hospitalization

Bullano¹,

Willey²,

Hauch³

et al. 2005

JMCP

114

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Longitudinal Evaluation of Health Plan Cost per Venous Thromboembolism or Bleed Event in Patients With a Prior Venous Thromboembolism Event During Hospitalization

Bullano¹,

Willey²,

Hauch³

et al. 2005

JMCP

114

View full text Add to dashboard Cite

“…23 However, in aretrospective analysis in ahealth maintenance organization in New Mexico, the total average cost for patients treated for aD VT in hospital with unfractionated heparin was $11,930.…”

mentioning

confidence: 99%

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

Spyropoulos

Lin²

2007

JMCP

294

233

View full text Add to dashboard Cite

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-...

show abstract

“…11 Tillman et al found that an outpatient program carried out in a health maintenance organization, enrolling 391 patients treated with initial enoxaparin and warfarin to 90 days, realized total cost savings of $1,108,587 over the 2-year evaluation period. 20 For patients with acute DVT, the American College of Chest Physicians (ACCP) recommends initial treatment with SC LMWH once or twice daily over UFH, as an outpatient if possible, or as an inpatient if necessary. 21 Yet, despite the accumulating evidence for the safety and cost-effectiveness of at-home treatment with LMWHs, there appears to be some reluctance among physicians to use such therapy.…”

Section: Ss Discussionmentioning

confidence: 99%

A Pilot Study of Home Treatment of Deep Vein Thrombosis With Subcutaneous Once-Daily Enoxaparin Plus Warfarin

Bishop¹,

Wilson²,

Post³

et al. 2006

JMCP

View full text Add to dashboard Cite

show abstract

Effectiveness and Economic Impact Associated With a Program for Outpatient Management of Acute Deep Vein Thrombosis in a Group Model Health Maintenance Organization

Abstract: Outpatient treatment of acute DVT can be managed safely and effectively in clinical practice. The potential savings associated with outpatient DVT treatment are substantial. Arch Intern Med. 2000;160:2926-2932

Cited by 80 publications

References 19 publications

Longitudinal Evaluation of Health Plan Cost per Venous Thromboembolism or Bleed Event in Patients With a Prior Venous Thromboembolism Event During Hospitalization

Longitudinal Evaluation of Health Plan Cost per Venous Thromboembolism or Bleed Event in Patients With a Prior Venous Thromboembolism Event During Hospitalization

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

A Pilot Study of Home Treatment of Deep Vein Thrombosis With Subcutaneous Once-Daily Enoxaparin Plus Warfarin

Contact Info

Product

Resources

About