Economic burden of long-term complications of deep vein thrombosis after total hip replacement surgery in the United States.
BACKGROUND
Estimates of the cost of long-term complications of a primary deep vein thrombosis (DVT), including the post-thrombotic syndrome (PTS) and recurrent venous thromboembolism (VTE), may be relevant for resource allocation decisions.


OBJECTIVE
The objective of this study was to provide US cost estimates of the long-term complications of a primary DVT, which occurs in approximately 5% to 20% (with adequate thromboprophylaxis) and 50% (in the absence of thromboprophylaxis) of total hip replacement surgeries (THRS).


METHODS
A literature-based model was used to project the excess long-term complication costs of DVT following THRS. The model simulated the natural history of DVT complications using published estimates of the incidence and prognosis of PTS and recurrent VTE. Each complication was assigned a cost obtained by multiplying the amount of resources used in its management by the unit price of these resources.


RESULTS
The annual per-patient cost of each complication was as follows: mild-to-moderate PTS, 839 dollars in the first year and 341 dollars in subsequent years; severe PTS, 3817 dollars in the first year and 1677 dollars in subsequent years; DVT, 3798 dollars; and pulmonary embolism, 6604 dollars. The average discounted lifetime cost of DVT complications was estimated to be 3069 dollars (95% interval 2091 dollars-4279 dollars).


CONCLUSIONS
The long-term complications of a primary DVT represent a significant economic burden. Preventing a DVT could arguably lead to substantial savings in long-term DVT complications.
Caprini
Joseph A
JA
Evanston Northwestern Healthcare, Evanston, IL, USA.
Botteman
Marc F
MF
Stephens
Jennifer M
JM
Nadipelli
Vijay
V
Ewing
Mary M
MM
Brandt
Suzanne
S
Pashos
Chris L
CL
Cohen
Alexander T
AT
D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D016022:Case-Control Studies; D017046:Cost Savings; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D015994:Incidence; D008017:Life Expectancy; D008134:Long-Term Care / Q000191:economics; D008297:Male; D008390:Markov Chains; D017059:Models, Econometric; D009010:Monte Carlo Method; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D020246:Venous Thrombosis / Q000191:economics* / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control / Q000523:psychology