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Abstract and Introduction
Abstract
Purpose: Deep-vein thrombosis (DVT) and pulmonary embolism (PE) are associated with major morbidity and mortality, with their burden often extending to longer-term complications such as event recurrence and post-thrombotic syndrome (PTS). Few data exist on the overall economic burden of DVT and PE and their sequelae. A retrospective observational cohort study was conducted to determine the direct medical costs of a DVT or PE patient across the entire continuum of care.
Summary: Administrative claims data for patients with a DVT or PE diagnosis (ICD-9-CM code) and patients with possible evidence of PTS between January 1, 1997, and March 31, 2004, were extracted from the PharMetrics Patient-Centric Database, which comprises fully adjudicated medical and pharmaceutical claims for U.S. health care-plan enrollees. Resource utilization and annualized direct medical costs of care for patients with DVT and/or PE were calculated and compared with matched controls.
A total of 26,958 patients met the study inclusion criteria. Of the 17,634 patients evaluable for the PTS cohort, 663 (3.8%) patients experienced PTS. Patients with DVT, PE, or DVT and PE had higher annualized direct medical costs before the index (initial) DVT and/or PE event (median: $7227, $6381, and $6771, respectively) than controls (median: $1045). During and after the DVT/PE event, annualized median costs rose to $17,512, $18,901, and $25,554, respectively, compared with $680 in the control group. Annualized median total costs for the PTS group were $20,569 compared with $15,843 in matched controls with DVT and/or PE and no PTS.
Conclusion: These data suggest that the initial acute DVT or PE event is associated with high total health care costs and that these costs are further increased by subsequent events such as recurrent DVT or PE and PTS. Early detection and appropriate treatment of this high-risk population have the potential for both clinical and economic benefits.
Introduction
Venous thromboembolism (VTE), including deep-vein thrombosis (DVT) and pulmonary embolism (PE), results in a major burden to the health care system, affecting both medical and surgical patients alike. With an estimated incidence of 0.1%, these conditions impact approximately 30 million Americans each year. The impact of VTE is highlighted by the fact that approximately 10% of hospital deaths can be attributed to PE.
The chronic burden of DVT and PE should not just be confined to the first symptomatic acute event. Despite initial management of a first DVT or PE, patients remain at high risk for recurrence, with 7-14% of patients experiencing a subsequent DVT or PE. The majority of recurrence is typically noted within three months following the incident DVT or PE event. Patients with a symptomatic DVT are also prone to developing post-thrombotic syndrome (PTS), which consists of chronic pain, swelling (edema) and, occasionally, ulceration of the leg. Between 15% and 50% of patients with DVT are estimated to develop PTS within 1-2 years of their first DVT. Severe PTS-involving debilitating pain, ulceration, and incapacitating limb swelling-affects 5-10% of patients following the occurrence of a DVT.
Although few data exist on the overall economic burden of DVT, PE, and their sequelae, the sheer number of patients affected and the known morbid and potentially fatal consequences of thromboembolic events point to both a substantial economic health care system burden as well as a societal burden related to these conditions. A study conducted from a managed-care perspective predicted that national (U.S.) annual expenditure on DVT events, excluding physician charges, may amount to $1.5 billion. In a recent retrospective cohort study in two large U.S. health care plans, the mean total reimbursed costs associated with VTE incidence were $7712 (median: $3131) for a DVT event, rising to $12,200 for a combined DVT and PE event (median: $6678). This study also showed that patients who experienced recurrent DVT, PE, or both incurred an additional mean total health care cost of $12,326 per event.
A number of studies have attempted to estimate the burden of DVT and PE in specific patient populations. For example, in a study of health care charges in patients who had undergone orthopedic surgery and subsequently developed DVT or PE, it has been shown that the average inpatient costs were twice those for a patient without DVT or PE. The mean total inpatient cost of care was estimated to be $9345 for the post-orthopedic patient with no thromboembolic complications compared with $17,114 for a patient with post-operative DVT and $18,521 for a patient with post-operative PE. The long-term complications after occurrence of a DVT and PE are more difficult to quantify, but it is recognized that PTS and its treatment represent a significant portion of the overall economic burden of DVT. After total hip replacement, the life-time costs of managing the complications of a post-operative DVT (recurrent DVT or PE and PTS) have been estimated, using a literature-based model, to be $3069 per patient per year.
In this study, we used a large, geographically diverse U.S. managed-care database to calculate the costs for a patient presenting with a DVT or PE across his or her entire continuum of care. The annualized episodic reimbursed costs reported in this study include not only the initial acute DVT or PE event but also the chronic longer term consequences, such as recurrent DVT and PE and PTS.
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