BACKGROUND: Recent studies suggest that thromboprophylaxis is beneficial in preventing venous thromboembolism (VTE) in cancer outpatients, but this is not widely adopted because of incomplete understanding of the contemporary incidence of VTE and concerns about bleeding. Therefore, the authors examined the incidence and predictors of VTE in ambulatory patients with bladder, colorectal, lung, ovary, pancreas, or gastric cancers. METHODS: Data were extracted from a large health care claims database of commercially insured patients in the United States between 2004 and 2009. Demographic and clinical characteristics of the cancer cohort (N ¼ 17,284) and an age/sex-matched, noncancer control cohort were evaluated. VTE incidence was recorded during a 3-month to 12-month follow-up period after the initiation of chemotherapy. Multivariate analyses were conducted to identify independent predictors of VTE and bleeding. RESULTS: The mean age of the study population was 64 years, and 51% of patients were women. VTE occurred in 12.6% of the cancer cohort (n ¼ 2170) over 12 months after the initiation of chemotherapy versus 1.4% of controls (n ¼ 237; P < .0001); incidence ranged by cancer type from 19.2% (pancreatic cancer) to 8.2% (bladder cancer). Predictors of VTE included type of cancer, comorbidities (Charlson Comorbidity Index score or obesity), and commonly used specific antineoplastic or supportive care agents (cisplatin, bevacizumab, and erythropoietin). CONCLUSIONS: This large, contemporary, real-world analysis confirmed high rates of VTE in select patients with solid tumors and suggested that the incidence of VTE is high in the real-world setting. Awareness of the benefits of targeted thromboprophylaxis may result in a clinically significant reduction in the burden of VTE in this population. Cancer 2013;119:648-55.
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-...
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.
Summary. Background: As hospitalized medical patients may be at risk of venous thromboembolism (VTE), evidence-based guidelines are available to help physicians assess patientsÕ risk for VTE, and to recommend prophylaxis options. The rate of appropriate thromboprophylaxis use in at-risk medical inpatients was assessed in accordance with the 6th American College of Chest Physicians (ACCP) guidelines. Methods: Hospital discharge information from the Premier Perspective TM inpatient data base from January 2002 to September 2005 was used. Included patients were 40 years old or more, with a length of hospital stay of 6 days or more, and had no contraindications for anticoagulation. The appropriateness of VTE thromboprophylaxis was determined in seven groups with acute medical conditions by comparing the daily thromboprophylaxis usage, including type of thromboprophylaxis, dosage of anticoagulant and duration of thromboprophylaxis, with the ACCP recommendations. Results: A total of 196 104 discharges from 227 hospitals met the inclusion criteria. The overall VTE thromboprophylaxis rate was 61.8%, although the appropriate thromboprophylaxis rate was only 33.9%. Of the 66.1% discharged patients who did not receive appropriate thromboprophylaxis, 38.4% received no prophylaxis, 4.7% received mechanical prophylaxis only, 6.3% received an inappropriate dosage, and 16.7% received an inappropriate prophylaxis duration based on ACCP recommendations. Conclusions: This study highlights the low rates of appropriate thromboprophylaxis in US acutecare hospitals, with two-thirds of discharged patients not receiving prophylaxis in accordance with the 6th ACCP guidelines. More effort is required to improve the use of appropriate thromboprophylaxis in accordance with the ACCP recommendations.
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