Home Treatment Compared to Initial Hospitalization in Normotensive Patients with Acute Pulmonary Embolism in the Netherlands: A Cost Analysis

Abstract

Background: Venous thromboembolism constitutes substantial healthcare costs amounting to about 60 million euros per year in the Netherlands. Compared to initial hospitalization, home treatment of pulmonary embolism (PE) is associated with a cost reduction. An accurate estimation of cost savings per patient treated at home is currently lacking. Aim: The aim of this study was to compare healthcare utilization and costs during the first 3 months after a PE diagnosis in patients who are treated at home versus those who are initially hospitalized. Methods: Patient-level data of the YEARS cohort study was used to estimate the proportion of patients treated at home, mean hospitalization duration in those who were hospitalized and rates of PE-related readmissions and complications. To correct for baseline differences within the two groups, regression analyses was performed. The primary outcome was the average total healthcare costs during a 3-month follow-up period for patients initially treated at home or in hospital. Results: Mean hospitalization duration for the initial treatment was 0.69 days for those treated initially at home (n=181) and 4.3 days for those initially treated in hospital (n=202). Total average costs per hospitalized patient were €3.204 and €1.507 per patient treated at home. The adjusted mean difference was €1.483 (95%CI €1.181 – 1.784). Conclusions: Home treatment of hemodynamically stable patients with acute PE was associated with an estimated net cost reduction of €1.483 per patient. This difference underlines the advantage of triage-based home treatment of these patients.

Cost‐of‐Illness Analysis of Long‐Term Health Care Resource Use and Disease Burden in Patients With Pulmonary Embolism: Insights From the PREFER in VTE Registry

“…New emerging management based on refined risk stratification, such as the early discharge and home treatment of patients with low‐risk PE, may significantly reduce costs for the index hospitalization. 52 , 53 On the other hand, the use of advanced interventional therapies, such as ultrasound‐assisted thrombolysis in intermediate high‐risk PE, may shift costs upwards. 54 Last but not least, the higher COVID‐19 associated risk for PE may increase the prevalence of patients post‐PE and, thus, increase the overall burden of disease for the population.…”