Hospital Costs of Acute Pulmonary Embolism

Fanikos, John; Rao, Amanda; Seger, Andrew C.; Carter, Danielle; Piazza, Gregory; Goldhaber, Samuel Z.

doi:10.1016/j.amjmed.2012.07.025

Cited by 107 publications

(34 citation statements)

References 30 publications

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“…The differences (rivaroxaban lower by $1135 unadjusted, $1888 adjusted) provide real‐world data corroborating a recent study by Mody et al,19 which evaluated the hospital costs of treating patients with rivaroxaban versus other anticoagulant agents using an economic model derived from the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET‐AF), EINSTEIN‐DVT and ‐PE, and the RECORD1‐3 randomized clinical trials, showing the potential cost‐savings at the upper bound of LOS difference as high as $2233 per patient (lower bound assumes no LOS difference). Further, the total hospital charges in our study are in reasonable agreement with other US data including the 2012 HCUP report, with mean costs for primary VTE at $9866, and the Brigham and Women's Hospital study reporting mean total costs at $8764 per patient (2003–2010 data) 17, 18…”

Section: Discussionsupporting

confidence: 89%

“…The mean LOS for VTE in the 2012 US HCUP data for primary DVT/PE hospitalizations was 4.9 days, and a study of 991 primary PE admissions at Brigham and Women's Hospital between 2003 and 2010 reported a mean LOS of 4.1±3.2 days (median 3 days) 17, 18. The mean LOS in these (nontrial) populations of 4.1 to 4.9 days, in addition to the EINSTEIN trial results, are a range within which our combined results fall, albeit in somewhat different populations.…”

Section: Discussionmentioning

confidence: 99%

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Shorter Hospital Stays and Lower Costs for Rivaroxaban Compared With Warfarin for Venous Thrombosis Admissions

Margolis

Deitelzweig

Kline

et al. 2016

JAHA

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BackgroundVenous thromboembolism, including deep vein thrombosis and pulmonary embolism, results in a substantial healthcare system burden. This retrospective observational study compared hospital length of stay (LOS) and hospitalization costs for patients with venous thromboembolism treated with rivaroxaban versus those treated with warfarin.Methods and ResultsHospitalizations for adult patients with a primary diagnosis of deep vein thrombosis or pulmonary embolism who were initiated on rivaroxaban or warfarin were selected from MarketScan's Hospital Drug Database between November 1, 2012, and December 31, 2013. Patients treated with warfarin were matched 1:1 to patients treated with rivaroxaban using exact and propensity score matching. Hospital LOS, time from first dose to discharge, and hospitalization costs were reported descriptively and with generalized linear models (GLMs). The final study cohorts each included 1223 patients (751 with pulmonary embolism and 472 with deep vein thrombosis). Cohorts were well matched for demographic and clinical characteristics. Mean (±SD) LOS was 3.7±3.1 days for patients taking rivaroxaban and 5.2±3.7 days for patients taking warfarin, confirmed by GLM‐adjusted results (rivaroxaban 3.7 days, warfarin 5.3 days, P<0.001). Patients with provoked venous thromboembolism admissions showed longer LOSs (rivaroxaban 5.1±4.5 days, warfarin 6.5±5.6 days, P<0.001) than those with unprovoked venous thromboembolism (rivaroxaban 3.3±2.4 days, warfarin 4.8±2.8 days, P<0.001). Days from first dose to discharge were 2.4±1.7 for patients treated with rivaroxaban and 3.9±3.7 for patients treated with warfarin when initiated with parenteral anticoagulants (P<0.001), and 2.7±1.7 and 3.7±2.1, respectively, when initiated without parenteral anticoagulants (P<0.001). Patients initiated on rivaroxaban incurred significantly lower mean total hospitalization costs ($8688±$9927 versus $9823±$9319, P=0.004), confirmed by modeling (rivaroxaban $8387 [95% confidence interval, $8035–$8739]; warfarin $10 275 [95% confidence interval, $9842–$10 708]).ConclusionsRivaroxaban was associated with significantly shorter hospital LOS and lower hospitalization costs compared with warfarin.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Shorter Hospital Stays and Lower Costs for Rivaroxaban Compared With Warfarin for Venous Thrombosis Admissions

Margolis

Deitelzweig

Kline

et al. 2016

JAHA

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“…Dyspnea assessment is of obvious importance in cardiopulmonary diseases and advanced cancer, but all hospitalized patients are at increased risk of cardiopulmonary issues such as pulmonary embolus and hospital-acquired pneumonia. For instance, pulmonary embolism carries a high fatality rate: 4.2% in hospital and 13.8% at 90 days after hospital discharge [15]. These events often occur in patients admitted for non-cardiopulmonary disorders including pregnancy, cancer, surgery, and trauma.…”

Section: Discussionmentioning

confidence: 99%

Routine dyspnea assessment and documentation: Nurses’ experience yields wide acceptance

2017

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BackgroundDyspnea (breathing discomfort) is a common and distressing symptom. Routine assessment and documentation can improve management and relieve suffering. A major barrier to routine dyspnea documentation is the concern that it will have a deleterious effect on nursing workflow and that it will not be readily accepted by nurses. Nurses at our institution recently began to assess and document dyspnea on all medical-surgical patients upon admission and once per shift throughout their hospitalization. A year after dyspnea measurement was implemented we explored nurses’ approach to dyspnea assessment, their perception of patient response, and their perception of the utility and burden of dyspnea measurement.MethodsWe obtained feedback from nurses using a three-part assessment of practice: 1) a series of recorded focus group interviews with nurses, 2) a time-motion observation of nurses performing routine dyspnea and pain assessment, and 3) a randomized, anonymous on-line survey based, in part, on issues raised in focus groups.ResultsNinety-four percent of the nurses surveyed reported administering the dyspnea assessment is “easy” or “very easy”. None of the nurses reported that assessing dyspnea negatively impacted workflow and many reported that it positively improved their practice by increasing their awareness. Our time-motion data showed dyspnea assessment and documentation takes well less than a minute. Nurses endorsed the importance of routine measurement and agreed that most patients were able to provide a meaningful rating of their dyspnea. Nurses found the patient report very useful, and used it in conjunction with observed signs to respond to changes in a patient’s condition.ConclusionsIn this study, we have demonstrated that routine dyspnea assessment and documentation was widely accepted by the nurses at our institution. Our nurses fully incorporated routine dyspnea assessment and documentation into their practice and felt that it improved patient-centered care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12912-016-0196-9) contains supplementary material, which is available to authorized users.

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“…Pulmonary embolism (PE) is a serious disease with significant morbidity and mortality rates and brings huge economic burden to society [1]. Inferior vena cava (IVC) filters were first developed in 1967 and now have been widely accepted as an effective method to prevent PE in patients with deep venous thrombosis (DVT) [2].…”

Section: Introductionmentioning

confidence: 99%

Bidirectional Pull-Back Technique for Retrieval of Strut-Embedded Cylinder-Shaped Filters in Inferior Vena Cava

Qian

et al. 2017

Med Sci Monit

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BackgroundIVC filters have been widely accepted as an effective method to prevent pulmonary embolism (PE) in patients with deep venous thrombosis (DVT). However, the placement of IVC filters is associated with significant complications and filter retrieval can be challenging when the filter struts are embedded into the caval wall.Material/MethodsOver 26 months, we reviewed the safety and efficacy of the bidirectional pull-back technique for removing strut-embedded IVC filters in 15 consecutive patients. Retrieval procedural data such as in-dwell time, retrieval time, and fluoroscopy time were recorded. Clinical outcomes and procedure-related complications were evaluated by venography or enhanced computed tomography. Histologic tissue was analyzed to reveal the pathologic effects of chronic filter implantation. All patients underwent routine clinical follow-up at a mean time of 12 months (range, 8–14 months).ResultsTechnical success of filter retrieval was achieved in 100%, with mean implantation of 46.6 days (range, 27–66 days). Filter types were as follows: OptEase (n=11) and Aegisy (n=4). The mean retrieval time and fluoroscopy time were 21.43±5.42 min and 7.63±2.67 min, respectively. Immediate postprocedure venography showed no procedure-related complications. Thirteen patients discontinued previously prescribed lifelong anticoagulation. There were no long-term complications during follow-up.ConclusionsThe bidirectional pull-back technique is safe and efficient for filter retrieval. This complex technique can be particularly useful in selected patients to remove strut-embedded cylindrical-shaped IVC filters previously considered irretrievable.

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Hospital Costs of Acute Pulmonary Embolism

Cited by 107 publications

References 30 publications

Shorter Hospital Stays and Lower Costs for Rivaroxaban Compared With Warfarin for Venous Thrombosis Admissions

Shorter Hospital Stays and Lower Costs for Rivaroxaban Compared With Warfarin for Venous Thrombosis Admissions

Routine dyspnea assessment and documentation: Nurses’ experience yields wide acceptance

Bidirectional Pull-Back Technique for Retrieval of Strut-Embedded Cylinder-Shaped Filters in Inferior Vena Cava

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