Outpatient Treatment in Low-Risk Pulmonary Embolism Patients Receiving Direct Acting Oral Anticoagulants Is Associated With Cost Savings

Abstract

Direct oral anticoagulants (DOAC) are first line treatment for pulmonary embolism (PE). Treatment of acute PE is traditionally hospital based and associated with high costs. The aims of this study were to evaluate potential cost savings with outpatient DOAC treatment compared to inpatient DOAC treatment in patients with low risk PE. A retrospective study in patients with DOAC treated low risk PE (simplified pulmonary severity index [sPESI] ≤ 1) admitted to 8 hospitals during 2013-2015. Health care costs were compared in 223(44%) patients treated as outpatients and 287(56%) treated in hospital. Total cost per patient was 8293 EUR in the inpatient group, and 2176 EUR in the outpatient group (p < 0.001). Total costs for inpatients were higher (p < 0.001) compared to outpatients in both subgroups with sPESI 0 and 1. In multivariate analysis, type of treatment (in- or outpatient, p = < 0.001) and sPESI group (0 or 1, p = < 0.001) were associated with total cost below or above median, whereas age (p = 0.565) and gender (p = 0.177) was not. Adherence to guidelines recommending outpatient treatment with DOAC in patients with low risk PE enables significant savings.

Pulmonary embolism with chronic obstructive pulmonary disease

“…At the same time, individualized intervention strategies were adopted according to risk stratification, including general support, anticoagulation, thrombolysis, intervention, and surgery 54 . At present, direct oral anticoagulant (DOAC) is the first‐line treatment for PE, 55 which can also be used for COPD combined with PE. According to the literature, subacute pulmonary embolism, as a kind of pulmonary embolism, has poor response to the early use of streptokinase 56 .…”

Value of Coronary Sinus During Computed Tomography Pulmonary Angiography for Predicting Pulmonary Hypertension in Patients with Acute Pulmonary Embolism

“…[1] More than 50% of PE treatment costs are related to inpatient care. [2] It remains challenging to identify which patients diagnosed with acute symptomatic PE in the emergency department may qualify for outpatient treatment.…”

A clinical decision framework to guide the outpatient treatment of emergency department patients diagnosed with acute pulmonary embolism or deep vein thrombosis: Results from a multidisciplinary consensus panel

“…More than 98% of patients treated as outpatients have an uncomplicated course 21 . Outpatient treatment is also associated with high patient satisfaction 17,18,22–26 at lower cost than inpatient hospitalization 27,28 . However, the definition of “outpatient treatment” varies widely in the published literature, including discharge from the ED or up to 48 hours on an inpatient floor 29 .…”

“…21 Outpatient treatment is also associated with high patient satisfaction 17,18,[22][23][24][25][26] at lower cost than inpatient hospitalization. 27,28 However, the definition of "outpatient treatment" varies widely in the published literature, including discharge from the ED or up to 48 hours on an inpatient floor. 29 In this article, we focused on care provided by emergency physicians, so we limit our definition of "outpatient treatment" to patients discharged from the ED or an ED observation unit.…”