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Venous thromboembolism: Annualised United States models for total, hospital-acquired and preventable costs utilising long-term attack rates

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
DOI: http://dx.doi.org/10.1160/TH12-03-0162
Issue: 2012: 108/2 (Aug) pp. 201-403
Pages: 291-302

Venous thromboembolism: Annualised United States models for total, hospital-acquired and preventable costs utilising long-term attack rates

C. E. Mahan (1), M. E. Borrego (2), A. L. Woersching (2), R. Federici (3), R. Downey (3), J. Tiongson (3), M. C. Bieniarz (3), B. J. Cavanaugh (3), A. C. Spyropoulos (4)

(1) New Mexico Heart Institute, University of New Mexico College of Pharmacy, Albuquerque, New Mexico, USA; (2) University of New Mexico College of Pharmacy, Albuquerque, New Mexico, USA; (3) New Mexico Heart Institute, Albuquerque, New Mexico, USA; (4) University of Rochester Medical Center, Rochester, New York, USA

Keywords

pulmonary embolism, Deep-vein thrombosis, Adverse event, cost model, venous thomboembolism, preventable costs, annualised, long-term attack rates

Summary

Healthcare reform is upon the United States (US) healthcare system. Prioritisation of preventative efforts will guide necessary transitions within the US healthcare system. While annual deep-vein thrombosis (DVT) costs have recently been defined at the US national level, annual pulmonary embolism (PE) and venous thromboembolism (VTE) costs have not yet been defined. A decision tree and cost model were developed to estimate US health care costs for total PE, total hospital-acquired PE, and total hospital-acquired “preventable” PE. The previously published DVT cost model was modified, updated and combined with the PE cost model to elucidate the same three categories of costs for VTE. Direct and indirect costs were also delineated. For VTE in the base model, annual cost ranges in 2011 US dollars for total, hospital- acquired, and hospital-acquired “preventable” costs and were $13.5-$27.2, $9.0-$18.2, and $4.5-$14.2 billion, respectively. The first sensitivity analysis, with higher incidence rates and costs, demonstrated annual US total, hospital-acquired, and hospital-acquired “preventable” VTE costs ranging from $32.1-$69.3, $23.7-$51.5, and $11.9-$39.3 billion, respectively. The second sensitivity analysis with long-term attack rates (LTAR) for recurrent events and post-thrombotic syndrome and chronic pulmonary thromboembolic hypertension demonstrated annual US total, hospital-acquired, and hospital-acquired “preventable” VTE costs ranging from $15.4-$34.4, $10.3-$25.4, and $5.1-$19.1 billion, respectively. PE costs comprised a majority of the VTE costs. Prioritisation of effective VTE preventative strategies will reduce significant costs, morbidity and mortality within the US healthcare system. The cost models may be utilised to estimate other countries’ costs or VTE-specific disease states.

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