The Economic Burden of Acute Venous Thromboembolism During One Year Following Diagnosis: A Population-Based Cohort Study

Abstract

AbstractAbstract 1152 Background:Although venous thromboembolism (VTE) is the third most common cardiovascular condition after myocardial infarct and stroke, few data exist on the economic burden associated with this condition. Objective:We aimed to quantify the economic burden of acute VTE in direct medical costs in the general population. Methods:Using the linked administrative healthcare databases of the province of Québec, Canada, including the provincial hospitalization database (MED-ÉCHO) and the healthcare claims databases of RAMQ which is a government agency that administers the provincial universal healthcare program, we determined a source population of all RAMQ beneficiaries with a physician visit or a hospitalization associated with an ICD-9-CM or ICD-10-CA diagnosis code for deep vein thrombosis (DVT) or pulmonary embolism (PE) between January 1, 2000 and December 31, 2009 and without a DVT or PE code prior to January 1, 2000. From the source population, we identified a cohort of Québec residents with a definite VTE and a cohort with a definite or probable VTE. We used a priori determined diagnostic algorithms using RAMQ and MED-ÉCHO data to identify definite and probable VTE cases. Subjects were followed forward in time from first VTE until the earliest of either death or end of study period (December 31, 2009). We determined the total direct cost per year for VTE by applying unit costs to the patient resource use profile in the year after diagnosis of VTE. Resource costs included hospitalizations, physician visits, and prescription medications. Resources were valued by the use of individual patient-level information from RAMQ and MED-ÉCHO. All costs were standardized to the 2009–2010 fiscal year costs, and are reported in Canadian dollars (year 2010 average US exchange rate 1.04). The RAMQ Manuel de Facturation and Manuel des Services de laboratoire en établissement was used to determine fees physician acts associated with a VTE diagnosis. The RAMQ List des médicaments contains information on drugs covered by the provincial drug insurance plan and was used to determine VTE-related drug costs. Because hospital costs are not available in Québec, we used the Ontario Case Costing Initiative to obtain hospital cost data. Hospitalizations for VTE–related outcomes were identified. The mean cost per person-years of follow-up was calculated as the sum of all costs during the year after VTE diagnosis divided by the total person-time of follow-up during that year. Results:From the 245 452 Québec residents between 2000 and 2009 with at least 1 VTE diagnosis in RAMQ or MED-ÉCHO, we identified 40 776 cases with definite VTE, and 14 027 cases with probable VTE. The average direct cost per person-year for VTE is $4,449.13 in the year following a definite VTE (Table 1) and $3,418.83 in the year following a definite or probable VTE. In both cohorts, the majority of cost was incurred by hospitalization for the initial VTE, and average cost after PE was higher than cost following DVT. Conclusions:The economic burden of VTE is large, and is mainly due to the initial VTE hospitalization. Use of measures favouring the safe out-patient treatment of VTE and the development of management strategies to identify patients with acute PE who can safely be treated in the ambulatory setting have the potential to decrease cost.Table 1Cost per person-year of resource use in the year following VTE diagnosis (definite cohort)VTEDVTPESubjects, N40,77624,86015,916Person-years31,79719,27612,521Cost per person-yearInitial VTE hospitalization2,863.361,454.835,031.68Follow-up resource use:1,585.771,426.481,831.00Diagnostic procedures:208.10213.58199.66VTE-related176.00180.40169.22Bleeding-related32.1033.1830.44Hospitalizations:573.86513.83666.28VTE recurrence265.19212.50346.31Bleeding276.37278.65272.86Post thrombotic syndrome12.0213.349.98CTEPH20.289.3437.14Treatments:490.21431.25580.98VTE Medications486.18428.06575.65Insertion of intravenous filter4.043.195.33Physician billed medical acts313.59267.81384.07Total cost (Canadian dollars)4,449.132,881.316,862.6Abbreviations: VTE, venous thromboembolism; DVT, deep vein thrombosis; PE, pulmonary embolism; CTEPH, chronic thromboembolic pulmonary hypertension. Disclosures:No relevant conflicts of interest to declare.