Prevention of venous thromboembolism in hospitalized patients: Analysis of reduced cost and improved clinical outcomes

Abstract

The impact of implementing a guideline on venous thromboembolism (VTE) prophylaxis was evaluated in a metropolitan private hospital with a before- and after-intervention study. This subsequent study aimed to identify if improved prophylaxis rates translated into cost savings and improved clinical outcomes. A conceptual decision-tree analytical model incorporating local treatment algorithms and clinical trial data was used to compare prophylaxis costs and clinical outcomes before and after the guideline implementation. The study analyzed data from 21,942 medical and surgical patients admitted to a 250-bed acute-care private hospital in Sydney, Australia. The modeled simulation estimated the incidence of symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE) as well as adverse events such as heparin-induced thrombocytopenia (HIT), post-thrombotic syndrome (PTS), major bleeding, and mortality. The costs of prophylaxis therapy and treating adverse events were also calculated. The improvement in prophylaxis rates following the implementation of the guideline was estimated to result in 13 fewer deaths, 84 fewer symptomatic DVTs, 19 fewer symptomatic PEs, and 512 fewer hospital-bed days. Improved adherence to evidence-based prophylaxis regimens was associated with overall cost savings of $245,439 over 12 months. We conclude that improved adherence to evidence-based guidelines for VTE prophylaxis is achievable and is likely to result in fewer deaths, fewer VTE events, and a significant overall cost saving.

Thromboprophylaxis following hip and knee arthroplasty

“…In 2013 Duff et al reported that a 20% improvement in adherence to an internal hospital thromboprophylaxis protocol was estimated to have resulted in 13 fewer deaths, 84 fewer symptomatic DVTs, 19 fewer symptomatic PEs, and 512 fewer hospital-bed days. 179 These improvements were associated with an overall cost saving of $245,429 over 12 months.…”

Risk Factors of a Pulmonary Thromboembolism After Colorectal Surgery

“…A large-scale, nationwide, retrospective study, which was designed to investigate a link between colorectal surgery and the development of VTE and PTE in the United States, found that VTE or PTE was clinically recognized in 2% of patients, with a close relationship with the following risk factors: malignant neoplasm, laparotomy, hypoalbuminemia, steroid treatment, obesity, older age, emergency admission, and ASA score (more than ASA 2) [ 14 ]. Risk factors associated with DVT and PTE in cancer patients were reported in a number of studies in Western countries, where multiple risk factors, such as diabetes mellitus, level of physical activity in patients, cardiac disorder and ethnicity, were presented [ 1 2 3 15 ]. Although a local study related to the development of postoperative VTE in Korean cancer patients showed that the incidence of VTE in patients who underwent colorectal cancer surgery was higher than it was in patients who underwent other types of surgeries, its occurrence in the Korean population was lower than that in the Western population [ 16 ].…”

“…A venous thromboembolism (VTE) may occur following a surgical procedure for a malignant neoplasm. The incidence of VTE after colorectal cancer surgery ranges from 1.4% to 2.4% [ 1 2 3 ]. VTE is one of the leading causes of significant morbidity and mortality in cancer patients after surgery.…”

The prevalence of combined pro-thrombotic polymorphisms in patients with recurrent deep vein thrombosis – does genetic testing provide any benefit?

“…When considering the management of possible complications -pulmonary embolism or venous leg ulcer -the cost of treatment is almost double. In the US the annual budget expenditure alone for DVT-associated treatment reaches approximately 6 billion USD [27][28][29]. In contrast, the annual costs of pharmacological prophylaxis (approximately 100-1000 USD per year, depending on the selected drug) and/or compression stockings (approximately 100-200 USD) for an individual patient do not exceed 500-600 USD.…”