Clinical and economic outcomes with appropriate or partial prophylaxis

Abstract

Introduction Despite the existence of evidence-based guidelines for venous thromboembolism (VTE) prevention, prophylaxis is often inappropriately prescribed. This study compared the efficacy, safety, and cost of appropriate (ACCP-recommended) prophylaxis with partial prophylaxis (not completely conforming to ACCP guidelines) in patients at-risk of VTE receiving enoxaparin or unfractionated heparin. Methods The MarketScan ® Hospital Drug Database from Thomson Reuters (January 2004–March 2007), was queried for medical and surgical patients at high risk of VTE, aged ≥ 40 years, and with a hospital stay ≥ 6 days. Univariate and multivariate analyses compared hospital-acquired VTE events, adverse events, and hospital costs between appropriate or partial prophylaxis discharges. Results Of the 21,001 discharge records included, appropriate prophylaxis was received by 5136 (24.5%) patients. Compared with partial prophylaxis, appropriate prophylaxis was associated with significantly lower incidences of hospital-acquired pulmonary embolism (0.9% vs 0.5%; adjusted odds ratio [OR] 0.55, 95% confidence intervals [CI] 0.35–0.87, P = 0.010), and bleeding events (10.7% vs 5.1%; adjusted OR 0.57, 95% CI 0.50–0.66, P < 0.001). Total costs per discharge were lower for appropriate prophylaxis ($17,386 ± 12,004) than partial prophylaxis ($23,823 ± 19,783) with an adjusted mean difference of $6370 in favor of appropriate prophylaxis ( P < 0.001). Conclusion This retrospective study suggests that ACCP-guideline recommended appropriate prophylaxis reduces hospital-acquired pulmonary embolism and bleeding events in patients at-risk of VTE and is cost-saving when total direct medical costs are considered. The substantial US clinical and economic VTE burden may, therefore, be reduced by improving prophylaxis adherence with guideline recommendations.