All-cause and disease-related health care costs associated with recurrent venous thromboembolism

Abstract

It was the objective of this study to quantify the risk of complications and the incremental health care costs associated with recurrent VTE events. Health care insurance claims from the Ingenix IMPACT database from 01/2004-09/2008 were analysed. Subjects aged ≥18 years on the date of first recurrent VTE diagnosis with ≥12 months of baseline observation prior to the index recurrent VTE were matched 1:1 with no-recurrent VTE patients based on propensity scores. The risk of developing post-thrombotic syndrome (PTS) and other disease-related diagnoses (thrombocytopenia, superficial venous thrombosis, venous ulcer, pulmonary hypertension, stasis dermatitis, and venous insufficiency) was compared between the recurrent and no-recurrent VTE groups for up to one year. All-cause and disease-related costs per patient per year (PPPY) were calculated. The recurrent VTE and no-recurrent VTE cohorts (8,001 subjects in each group) were matched with respect to age, gender, and comorbidities. The risk ratios (RRs) indicated that the risk of developing post-event complications was significantly higher for the recurrent VTE group compared to the no-recurrent VTE group (RR [95% CI]: PTS: 2.7 [2.4 - 2.9], p-value <0.01). Patients with recurrent VTE had significantly higher average PPPY all-cause costs compared to no-recurrent VTE patients ($86,744 versus $37,525, cost difference: $49,219 [€33,617]; 95% CI= 46,253-51,989). Corresponding disease-related health care costs PPPY were also significantly higher for the recurrent VTE group ($11,120 vs $1,262, cost difference: $9,858 [€6,733]; 95% CI= $9,081-$10,476). In conclusion, in this large matched-cohort study, recurrent VTE patients had significantly higher risk of complications and health care costs compared to no-recurrent VTE patients.

The economic burden of incident venous thromboembolism in the United States: A review of estimated attributable healthcare costs

“…The average cost for patients with recurrent VTE may also be higher because of comorbid conditions. In one study patients who had a recurrence within 12 months had average annualized expenditure $55,100 higher, but just one-fifth of the difference in expenditures, $11,000, was attributable to the treatment of VTE and complications [33]. …”

Healthcare resource utilization and costs associated with venous thromboembolism in cancer patients treated with anticoagulants

“…Another study found that the average cost of a hospitalization in patients with cancer was over $20,000 for DVT alone or concomitant DVT and PE 14 . Furthermore, recurrent VTEs are considerably more expensive to manage, with the additional total all-cause cost of care associated with them estimated to be $50,000 at 1 year 15,16 .…”

Postthrombotic Syndrome in Patients Treated With Rivaroxaban or Warfarin for Venous Thromboembolism

“…No specific ICD-9-CM code(s) exist to indicate a diagnosis of PTS are available 1 ; therefore, the occurrence of symptoms of PTS during follow-up was determined using an algorithm developed by MacDougall and colleagues 18 and used in multiple prior claims database studies. 19–20 The algorithm takes into account the syndrome, often waxing-and-waning nature of the disease. 1,18 The MacDougall algorithm 18 defines PTS as a code for ≥1 extremity venous study including Doppler waveform analysis or venous plethysmography (CPT-4 = 93 965-93 971) along with diagnosis code(s) for both pain ( ICD-9-CM = 729.5) and swelling of the limb ( ICD-9-CM = 729.81) within 7 days of each other, lower extremity varicose veins ( ICD-9-CM = 454.xx) with or without ulcer and/or inflammation, postphlebitic syndrome ( ICD-9-CM = 459.1x) with or without ulcer and/or inflammation, or other disorder of the circulatory system ( ICD-9-CM = 459.8x) at least 3 months after the index VTE event (Supplemental Table 1).…”