Thromboprophylaxis in medically ill patients at risk for venous thromboembolism.
OBJECTIVE
According to guidelines from the American College of Chest Physicians, low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) should be prescribed to medical (nonsurgical) patients at high risk of venous thromboembolism. Thromboprophylaxis and mortality rates were determined in medical inpatients with indications for thromboprophylaxis. Cost differences between patient groups were investigated and are discussed.


CONCLUSIONS
Using Solucient's ACTracker Inpatient Database, medical discharges between January 2001 and December 2004 were extracted and patients who had indications for thromboprophylaxis (acute myocardial infarction, ischemic stroke, cancer, heart failure, or severe lung disease) were identified. Patients < 40 years or with deep-vein thrombosis or pulmonary embolism, active peptic ulcer, malignant hypertension, blood disease, HIV infection, or intubation of gastrointestinal or respiratory tract were excluded. Rates of thromboprophylaxis and mortality were compared between groups. Mean total drug costs and hospital costs per patient discharge were compared between patient groups. Of 12,887,080 medical discharges extracted from 330 hospitals, there were 2,367,362 patients with indications for thromboprophylaxis. Patients were subdivided on the basis of whether they received thromboprophylaxis (n = 717,850) or not (n = 1,649,512). The thromboprophylaxis rate was low, despite increasing from 26% to 33% over the study period. Patients receiving thromboprophylaxis had significantly lower risk-adjusted mortality rates than those who did not (p < 0.001), except those with ischemic stroke. The mean total drug cost per patient receiving LMWH and UFH ($791 and $569, respectively) was higher than for patients not receiving thromboprophylaxis ($372) (p < 0.001). The mean total hospital cost per patient receiving UFH ($7615) was higher than for LMWH ($6866, p < 0.001).


CONCLUSIONS
The thromboprophylaxis rate among medical patients was low, with no significant improvement between 2001 and 2004. Thromboprophylaxis can impact patient mortality rates. Economic evaluation revealed that the use of LMWH for thromboprophylaxis in at-risk medical patients was associated with higher total drug costs but lower total hospital costs than UFH. Efforts should be made to increase clinicians' awareness of clinical guidelines.
Burleigh
Edward
E
Solucient Inc., Evanston, IL, USA.
Wang
Cheng
C
Foster
David
D
Heller
Sivana
S
Dunn
Dennis
D
Safavi
Kaveh
K
Griffin
Brian
B
Smith
Jeff
J
D003627:Data Interpretation, Statistical; D016208:Databases, Factual / Q000706:statistics & numerical data; D016527:Drug Costs; D005260:Female; D006333:Heart Failure / Q000150:complications; D006495:Heparin, Low-Molecular-Weight / Q000191:economics / Q000627:therapeutic use*; D017721:Hospital Costs / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007362:Intensive Care Units / Q000191:economics; D007902:Length of Stay / Q000191:economics; D008297:Male; D009203:Myocardial Infarction / Q000150:complications; D009369:Neoplasms / Q000150:complications; D010351:Patient Discharge / Q000191:economics; D012307:Risk Factors; D020521:Stroke / Q000150:complications; D013923:Thromboembolism / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D013997:Time Factors
D006495:Heparin, Low-Molecular-Weight