Economic Burden Associated with Major Surgery in Patients with von Willebrand Disease: A United States Retrospective Administrative Database Analysis

Abstract

Purpose

To estimate the incremental economic burden of major surgeries in patients with von Willebrand disease (VWD).

Patients and Methods

This was a retrospective analysis of the IBM Health MarketScan^® database (2008–2018). Patients with at least two healthcare visits for VWD in the database who had undergone at least one major surgery unrelated to VWD (identified via International Classification of Diseases, Ninth and Tenth Revisions procedure codes) were included. Patients without VWD with major surgeries were selected from a 1% random database sample. All patients had ≥12 months of continuous healthcare plan enrollment before and following their first major surgery. Patients with VWD were matched (1:1) with patients without VWD using propensity score matching. Regression models compared healthcare resource utilization and costs between the matched cohorts over a 12-month period after patients’ index major surgery.

Results

After propensity score matching, 2972 pairs were selected. Musculoskeletal and digestive surgeries were the two most common major surgeries (patients with VWD, 39.6% and 25.0%; without VWD, 37.1% and 23.4%, respectively). Patients with VWD were significantly more likely (p<0.0001) to have an inpatient admission (odds ratio = 1.71; 95% confidence interval [CI] 1.52–1.92) or emergency room visit (odds ratio = 1.41; 95% CI 1.25–1.59) than patients without VWD. The numbers of inpatient admissions (incidence rate ratio [IRR] = 1.47; 95% CI 1.35–1.60), emergency room visits (IRR = 1.44; 95% CI 1.31–1.59), and outpatient visits (IRR = 1.16; 95% CI 1.11–1.21) per patient were also significantly greater for patients with VWD than for those without VWD (p<0.0001). Patients with VWD incurred significantly higher (p<0.0001) total healthcare costs (medical and pharmacy) per patient than patients without VWD ($50,733.89 versus $30,154.84, respectively).

Conclusion

Healthcare resource utilization and associated costs among patients undergoing major surgeries were significantly higher for those with VWD than for patients without VWD.

Keywords:

• bleeding
• healthcare costs
• retrospective studies
• healthcare resource utilization

Previous Presentation

Poster presentation (#4602) at 61st American Society of Hematology (ASH) Annual Meeting, December 7–10, 2019, Orlando, FL, USA.

Abbreviations

CCI, Charlson Comorbidity Index; CI, confidence interval; CPT, Current Procedural Terminology; ER, emergency room; FVIII, factor VIII; HCRU, healthcare resource utilization; IRR, incidence rate ratio; OR, odds ratio; PCS, procedure coding system; SD, standard deviation; VWD, von Willebrand disease; VWF, von Willebrand factor.

Data Sharing Statement

Data are the proprietary property of IBM.

Ethics Approval and Informed Consent

Not applicable; no institutional review board approval was required for this retrospective claims database analysis because only de-identified data were used. All data analyzed in the present study complied with the requirements of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 for fully de-identified datasets.

Consent for Publication

Not applicable.

Acknowledgments

Under the direction of the authors, medical writing support for this manuscript was provided by Joanne Vaughan, employee of Excel Medical Affairs (Fairfield, CT, USA), and was funded by Takeda Development Center Americas, Inc., Lexington, MA, USA.

Author Contributions

All authors made a significant contribution to the work reported, whether that was in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas (AO, YW, ML, SF, and BE contributed to the study design, interpretation of the data, and preparation of the manuscript. YW analyzed the data); took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Abiola Oladapo was an employee of Baxalta US Inc., a Takeda company, at the time the analysis was completed and the manuscript developed and is an owner of Takeda stock. Yanyu Wu, Mei Lu, Sepehr Farahbakhshian, and Bruce Ewenstein are employees of Takeda Development Center Americas, Inc., and are owners of Takeda stock.

Additional information

Funding

This study was funded by Shire US Inc., a Takeda company, Lexington, MA, USA. The study sponsor was involved with the study design, analysis and interpretation of data, writing of the manuscript, and decision to publish the article.