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Economic Burden of Deep Vein Thrombosis

Authors

Tim Casey

Orlando—In a recent cohort study of 355 patients diagnosed with acute deep vein thrombosis (DVT) at 7 hospitals in Quebec, Canada, researchers found that the average per patient total cost associated with DVT was $5094 (Canadian), with most of the costs occurring within 4 months of diagnosis. Raphael Guanella, MD, the trial’s lead author, presented the findings of VENOUS (Venous Thrombosis Outcomes Study) during an oral abstract session at the ASH meeting. Dr. Guanella said a few previous studies focused on the short- or medium-term costs of DVT, a common and serious vascular condition affecting adults that is typically complicated by the chronic postthrombotic syndrome (PTS). However, the authors in VENOUS were interested in evaluating the longer term economic burden associated with DVT as well as nonmedical costs, such as loss of productivity, family or caregiver assistance, and transportation. The patients were recruited from 2001 through 2004 and followed for 2 years after diagnosis. Patients met with clinicians 1, 4, 8, 12, and 24 months after diagnosis and underwent assessments for PTS at each visit. The medical costs assessed included hospitalizations, physician and nonphysician healthcare visits, prescription and over-the-counter medications, compression stockings, and assistive devices. The researchers tracked the data through patient-completed cost diaries filed each week during the first year and for 3 randomly chosen months during the second year, nurse-completed case report forms at diagnosis, each follow-up visit, and any DVT-related clinical event, and Quebec provincial administrative healthcare databases (RAMQ and Med-Echo). RAMQ collects information regarding outpatient prescription medications and physician visits, while Med-Echo contains information about hospitalizations. The databases identify patients with unique health identifier numbers; DVT-related resources were identified using specific International Classification of Diseases, Ninth Revision, codes and drug identification numbers. The mean age of the patients was 57 years (range, 21-96 years). Half of the patients were male, 70% were outpatients, 58% had proximal DVT, and 15% had a concomitant pulmonary embolism (PE). In addition, 46% of the DVTs were unprovoked, 41% were due to transient factors, and 13% were provoked by cancer. On average, the patients had 15.0 physician visits, 0.7 nonphysician healthcare visits, and 12.1 lost work days during the 2 years. They also required 38.6 hours of assistance and 12.7 transportations, according to the study. Of the $5094 average per patient cost over the 2 years, 53% was attributed to nonmedical factors. Of the $2447 average per patient cost attributed to medical costs, 64% was attributed to hospitalizations, 17% was attributed to physician visits, 15% was attributed to drug costs, and 4% was attributed to other factors. Of the $2647 average per patient cost attributed to nonmedical costs, 58% was attributed to lost work days, 33% was attributed to assistance, and 9% was attributed to transportation. The researchers used a multivariate regression modeling approach to predict indicators of medical costs. They determined the following factors were statistically significant: PE at baseline (P<.001), unprovoked DVT (P<.001), and PTS during follow-up (P<.01). The following factors were not predictive of costs: age, sex, body mass index, localization of DVT, features of DVT, history of previous venous thromboembolism, cardiovascular risk factors, and other comorbid conditions.

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