Economic and utilization outcomes associated with choice of treatment for venous thromboembolism in hospitalized patients.
OBJECTIVE
Hospital administrative data were analyzed to assess treatment patterns, in-hospital mortality, rates of hemorrhagic events and thrombus propagation, utilization of health care resources, and hospital costs associated with various treatments during inpatient care for venous thromboembolism (VTE).


METHODS
Data from inpatient records were collected for deep venous thrombosis (DVT) and pulmonary embolism (PE) encounters at 132 US hospitals between January 1999 and December 2000. Patients receiving the most frequently employed treatments were compared with respect to demographics, related procedures and diagnostics, length of stay, adverse events, in-hospital mortality, and hospital costs.


RESULTS
A total of 953 primary DVT and 3933 primary PE admissions were identified. Most admissions involved treatment with unfractionated heparin and vitamin K antagonist (UFH/VKA, 64.2% of admissions), followed by UFH with VKA and low-molecular-weight heparin (UFH/LMWH/VKA, 14.4%), and LMWH/VKA (12.9%). Compared with those treated with UFH/VKA, patients treated with LMWH/VKA experienced higher anticoagulant costs (dollar 540 vs. dollar 106), but lower total hospital costs (dollar 5198 vs. dollar 5977) and shorter lengths of stay (4.4 vs. 5.7 days for those without PE and 5.7 vs. 6.7 days for those with PE).


CONCLUSIONS
UFH/VKA was the most common regimen used to treat VTE. In spite of its higher medication cost, however, treatment with LMWH/VKA was associated with significantly shorter hospital stays and lower total hospitalization costs, compared with UFH/VKA.
Knight
Kevin K
KK
Cerner Health Insights, Beverly Hills, CA 90212, USA.
Wong
John
J
Hauch
Ole
O
Wygant
Gail
G
Aguilar
Daniel
D
Ofman
Joshua J
JJ
D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects / Q000145:classification / Q000191:economics / Q000627:therapeutic use*; D001780:Blood Coagulation Tests / Q000191:economics / Q000706:statistics & numerical data; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D014481:United States / Q000453:epidemiology; D014600:Utilization Review / Q000191:economics*; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D014859:Warfarin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; C078918:ITF 300; D014859:Warfarin; D006493:Heparin