Review of the cost of venous thromboembolism

Figures & data

Figure 1 Flow diagram: economic analyses.

Table 1 Economic studies reporting costs of treatment of venous thromboembolism in the USA\

Year(s) of study, reference	Type of study	Population	Costing period	Type of costs	Costs
					VTE (DVT and/or PE)	DVT	PE	DVT + PE
Hospital perspective
1996–1998 Groce^Citation22	Prospective cohort study in a hospital	125 patients with acute DVT on an outpatient DVT treatment strategy with LMWH	3 months	Total mean direct costs		$965 (outpatient) $3,436 (inpatient)
1999–2000 Knight et al^Citation9	Retrospective, observational study using a large administrative hospital database	Hospitalized patients with: DVT, n=953 PE, n=3,933	Initial hospital stay (4–7 days) and readmissions within 30 days	Total mean hospital costs per stay		$3,018–$5,040	$5,198–$6,928
2005–2008 Bonafede et al^Citation11	Retrospective economic analysis of hospital discharge data from US acute care hospitals	Hospitalized patients with VTE treated with: fondaparinux, n=366 enoxaparin, n=14,674	Hospital stay and readmissions within 30 days	Charges for index anticoagulant during admission and readmissions within 30 days	Fondaparinux: $2,233 Enoxaparin: $2,497 After adjustment: fondaparinux was $409 lower; P=0.001
2002–2006 Merli et al^Citation12	Retrospective economic analysis of hospital discharges and billing records from a large, hospital database	Patients with primary diagnosis of VTE treated with: LMWH, n=32,959 UFH, n=24,172	Hospital stay (4.4–5.6 days) and readmission within 30 and 90 days	Adjusted total inpatient direct medical costs per hospital discharge	UFH: $3,476.22 LMWH: $3,056.42
2002–2006 Merli et al^Citation13	Retrospective economic analysis of hospital discharges and billing records from a large hospital database	Hospitalized patients with primary diagnosis of VTE treated with: enoxaparin, n=352,072 UFH, 542,292	Hospital stay (4.7–5.3 days) and readmissions within 30 and 90 days	Adjusted total inpatient direct medical costs per hospital discharge	Enoxaparin: $5,363 UFH: $6,443
2003–2010 Fanikos et al^Citation10	Retrospective analysis of hospital medical records	991 hospitalized patients with primary diagnosis of PE	LOS (median 3 days)	Total mean hospital costs per stay			$8,764
Health plan perspective
1996–1998 Tillman et al^Citation23	Prospective cohort study implemented among members of a health plan	391 patients with acute DVT in an outpatient management strategy	3 months	Total mean direct costs incurred by the health plan		$1,868 (outpatient) $4,696 (inpatient)
1997 O’Brien and Caro^Citation14	Retrospective analyses of hospital discharge data, emergency department, and ambulatory care databases, agency reports, and peer-	29,295 patients discharged for DVT	LOS (mean): 5.8 days 6 months	Total mean hospital cost per stay (reported in 1999) Total mean inpatient and outpatient costs (reported in 1999)		$5,779 (first admission) $6,946 (readmission) $10,072		$14,649
1997–2001 Bullano et al^Citation15	Retrospective observational study of medical and pharmacy administrative claims of two large health care plans	2,147 patients with a VTE hospital claim: DVT, n=1,499 PE, n=373 DVT + PE, n=275	LOS (5.3–8.3 days)	Mean total hospital costs per event paid by the health plan to the provider	$8,331 $12,326 (per recurrent event with hospitalization)	$7,712 $11,419 (per recurrent event with hospitalization)	$9,566 $11,014 (per recurrent event with hospitalization)	$12,200 $19,237 (per recurrent event with hospitalization)
			21-month follow-up period	Mean costs for recurrent VTE, bleeding, and anticoagulation treatment	$14,975 (per recurrent event during follow-up period)
1997–2004 MacDougall et al^Citation20	Retrospective observational cohort study of medical and pharmaceutical claims of a managed care database	Patients with: DVT, n=15,679 PE, n=7,653 DVT + PE, n=2,932	12 months	Total mean adjusted annual all-cause costs including recurrent events (in 2004)		$33,200	$31,270	$38,296
1998–2004 Spyropoulos and Lin^Citation16	Retrospective, observational cohort study of medical claims of a managed care database	14,108 patients with a primary or secondary discharge diagnosis of DVT or PE	LOS (7.4–8.7 days)	Total mean hospital cost per stay		$9,805 (first admission) $11,862 (readmission)	$14,146 (first admission) $14,722 (readmission)
			12 months	Total mean annual inpatient and outpatient costs		$10,804 (primary diagnosis) $7,594 (secondary diagnosis)	$16,644 (primary diagnosis) $13,018 (secondary diagnosis)	$27,909 (secondary diagnosis)
2004–2008 Lefebvre et al^Citation21	Retrospective analysis of commercial and Medicare databases	16,969 patients with VTE: DVT, n=12,711 PE, n=2,473 DVT + PE, n=1,785	12 months	Total all-cause health care cost per patient with VTE per year (in 2008)	$33,531
2008–2011 Lin et al^Citation19	Retrospective analysis of commercial and Medicare databases	29,275 with VTE commercially insured and 14,509 patients with VTE Medicare insured (15.4% and 11.4% of patients, respectively, experienced a VTE recurrence within 12 months of VTE index)	12 months	Total annual VTE-related care per patient	$15,123 (commercially insured) $38,591 (recurrent, commercially insured) $10,399 (Medicare insured) $24,137 (recurrent VTE, Medicare insured)
				Total “all-cause” inpatient and outpatient costs per patient with VTE per year	$36,918 (commercially insured) $82,110 (recurrent VTE, commercially insured) $31,203 (Medicare insured) $55,982 (recurrent VTE, Medicare insured)

Note: All currencies are in US$.

Abbreviations: DVT, deep vein thrombosis; LMWH, low-molecular-weight heparin; LOS, length of stay; PE, pulmonary embolism; UFH, unfractionated heparin; VTE, venous thromboembolism.

Table 2 Economic studies reporting costs of treatment of venous thromboembolism in European countries and in Canada

Country, year(s) of study, reference	Type of study		Population	Costing period	Type of costs	Costs, mean
						VTE	DVT	PE
Cost per VTE hospitalization
Belgium 1998 Annemans et al^Citation27		Retrospective patient chart review	54 patients with PE from five centers	Mean LOS (14.6 days)	Per inpatient cost			€3,394
Italy 2010 Gussoni et al^Citation28		Retrospective economic analysis of data collected within 26 centers in Italy	160 inpatients with VTE treated with antithrombotic prophylaxis	LOS (10.6 days)	In-hospital costs strictly related to VTE management	€1,349 (median value)
Costs of VTE management
Canada 2001–2004 Guanella et al^Citation29		Prospective database study in ED clinics and outpatient and inpatient departments	355 consecutive patients with acute DVT (two/three outpatients)	24 months	Total VTE – all-cause costs per patient during 2 years (in Can $ 2010)		Can $2,503
France 1999 Tilleul et al^Citation30		Retrospective analysis using published literature, public databases, and practitioners’ opinions	216,916 patients hospitalized for major orthopedic surgery: DVT, n=287; PE, n=665	12 months	Mean annual all-cause medical cost per patient, per event		€1,926 (DVT occurring during index hospitalization) €3,181 (new hospitalization for DVT) €523 (DVT treated as outpatient)	€2,971 (PE occurring during index hospitalization) €4,963 (new hospitalization for PE during follow-up)
Germany 2000–2006 Kroger et al^Citation26		Retrospective analysis of a random sample of health care data from a statutory health insurance fund	176 first-year survivors post-PE diagnosis	12 months	Excess costs compared with matched control, reimbursed by the health plan per patient per year after index event			€5,816 (men) €8,960 (women)

Abbreviations: DVT, deep vein thrombosis; ED, emergency department; LOS, length of stay; PE, pulmonary embolism; VTE, venous thromboembolism.

Table 3 Economics studies reporting length of hospital stay for venous thromboembolism treatment in the USA and European countries

Country/years	Population	Length of hospital stay (days), mean, unless otherwise noted				Reference
		VTE	DVT	PE	DVT + PE
USA 1997	Patients discharged for DVT		5.8			O’Brien and Caro^Citation14
1997–2004	Patients with DVT, PE, and DVT + PE		7	6	9	MacDougall et al^Citation20
2003–2010	Hospitalized patients with primary diagnosis of PE			3 (median)		Fanikos et al^Citation10
1999–2000	Hospitalized patients with DVT and PE treated with different anticoagulant therapies		UFH/LMWH/VKA: 5.76	UFH/LMWH/VKA: 7.11		Knight et al^Citation9
			UFH/VKA: 5.69	UFH/VKA: 6.68
			LMWH/VKA: 4.40	LMWH/VKA: 5.65
1998–2004	Patients with a primary or secondary discharge diagnosis of DVT or PE			7.7 (first admission)	7.4 (first admission)	Spyropoulos and Lin^Citation16
				8.7 (readmission)	7.6 (readmission)
2008–2011	Patients with VTE commercially or Medicare insured	3.4				Lin et al^Citation19
		8–8.4 (recurrent VTE within 12 months of first event)
Belgium 1998	Patients with PE			14.6		Annemans et al^Citation27
France 1999	Patients hospitalized for major orthopedic surgery with DVT or PE		3.3–6.3	4.6–6.6		Tilleul et al^Citation30
Germany 2000–2006	Hospitalized patients with PE			21.4 (men)		Kroger et al^Citation26
				23.6 (women)
Italy 2010	Hospitalized patients with VTE	10.6				Gussoni et al^Citation28

Abbreviations: DVT, deep vein thrombosis; LMWH, low-molecular-weight heparin; PE, pulmonary embolism; UFH, unfractionated heparin; VKA, vitamin K antagonist; VTE, venous thromboembolism.

GroceJBIIIPatient outcomes and cost analysis associated with an outpatient deep venous thrombosis treatment programPharmacotherapy199818175S180S9853912

 PubMedGoogle Scholar

KnightKKWongJHauchOWygantGAguilarDOfmanJJEconomic and utilization outcomes associated with choice of treatment for venous thromboembolism in hospitalized patientsValue Health2005819120015877591

 PubMed Web of Science ®Google Scholar

BonafedeMMShorrAFJohnsonBHHorblyukRFondaparinux is economically non-inferior to enoxaparin for the treatment of venous thromboembolismValue Health200912A142

 Web of Science ®Google Scholar

MerliGFerrufinoCLinJHusseinMBattlemanDHospital-based costs associated with venous thromboembolism treatment regimensJ Thromb Haemost200861077108618445118

 PubMed Web of Science ®Google Scholar

MerliGFerrufinoCPLinJHusseinMBattlemanDHospital-based costs associated with venous thromboembolism prophylaxis regimensJ Thrombosis Thrombolysis201029449458

 PubMed Web of Science ®Google Scholar

FanikosJRaoASegerACCarterDPiazzaGGoldhaberSZHospital costs of acute pulmonary embolismAm J Med201312612713223331440

 PubMed Web of Science ®Google Scholar

TillmanDJCharlandSLWittDMEffectiveness and economic impact associated with a program for outpatient management of acute deep vein thrombosis in a group model health maintenance organizationArch Intern Med20001602926293211041899

 PubMed Web of Science ®Google Scholar

O’BrienJACaroJJDirect medical cost of managing deep vein thrombosis according to the occurrence of complicationsPharmacoeconomics20022060361512141888

 PubMed Web of Science ®Google Scholar

BullanoMFWilleyVHauchOWygantGSpyropoulosACHoffmanLLongitudinal evaluation of health plan cost per venous thromboembolism or bleed event in patients with a prior venous thromboembolism event during hospitalizationJ Manag Care Pharm20051166367316194130

 PubMedGoogle Scholar

MacDougallDAFeliuALBoccuzziSJLinJEconomic burden of deep-vein thrombosis, pulmonary embolism, and post-thrombotic syndromeAm J Health-Syst Ph20066320 supplS5S15

 Google Scholar

SpyropoulosACLinJDirect medical costs of venous thromboembolism and subsequent hospital readmission rates: An administrative claims analysis from 30 managed care organizationsJ Manag Care Pharm20071347548617672809

 PubMed Web of Science ®Google Scholar

LefebvrePLalibertéFNutescuEAAll-cause and potentially disease-related health care costs associated with venous thromboembolism in commercial, Medicare, and Medicaid beneficiariesJ Manag Care Pharm20121836337422663169

 PubMedGoogle Scholar

LinJPreblickRLingohr-SmithMKwongWJIncremental healthcare resource utilization and economic burden of venous thromboembo-lism recurrence from a US payer perspectiveJ Manag Care Pharm20142017418624456319

 PubMed Web of Science ®Google Scholar

AnnemansLRobaysHBruartJVerstraetenPVariation in medical resource utilization in the management of pulmonary embolism in BelgiumActa Clin Belg200257111812017750

 PubMed Web of Science ®Google Scholar

GussoniGFogliaEFrassonSon behalf of the FADOI Permanent Study Group on Clinical GovernanceReal-world economic burden of venous thromboembolism and antithrombotic prophylaxis in medical inpatientsThromb Res2013131172323141845

 PubMed Web of Science ®Google Scholar

GuanellaRDucruetTJohriMEconomic burden and cost determinants of deep vein thrombosis during 2 years following diagnosis: a prospective evaluationJ Thromb Haemost201192397240521951970

 PubMed Web of Science ®Google Scholar

TilleulPLaFumaAColinXOzierYEstimated annual costs of prophylaxis and treatment of venous thromboembolic events associated with major orthopedic surgery in FranceClin Appl Thromb-Hem200612473484

 PubMed Web of Science ®Google Scholar

KrogerKKupper-NybelenJMoerchelCMoysidisTKienitzCSchubertIPrevalence and economic burden of pulmonary embolism in GermanyVasc Med (United Kingdom)201217303309

 Google Scholar