Hospital-based costs associated with venous thromboembolism treatment regimens.
BACKGROUND
Venous thromboembolism (VTE) poses a significant health and economic burden in US hospitals. Clinical guidelines for acute VTE treatment recommend antithrombotic therapy (at least 5 days) with low molecular weight heparin (LMWH) or unfractionated heparin (UFH). With upcoming US national performance measures requiring successful implementation of evidence-based therapy, cost considerations for anticoagulant choice are of increasing importance to hospitals.


METHODS
This retrospective cohort analysis utilizes discharge records from a large real-world US population (January 2002 to December 2006) to provide total, direct, inpatient medical costs associated with LMWH and UFH for acute VTE treatment. Furthermore, for both LMWH and UFH discharges, we compare VTE-related readmission rates at 30 and 90 days after discharge.


RESULTS
In total, 57 131 discharges were identified (57.7% LMWH; 42.3% UFH). After adjustment for covariates, including age, severity of illness, and length of stay, total direct medical costs per hospital discharge for UFH were $3476.22 vs. $3056.42 for LMWH (P < 0.0001; difference $420). Costs were significantly higher in the UFH group for most cost categories. Notably, drug acquisition cost was higher for LMWH. LMWH treatment was 12% [odds ratio (OR) 0.876; P < 0.001] and 10% (OR 0.895; P = 0.0006) less likely to result in VTE readmission within 30 and 90 days, respectively.


CONCLUSIONS
This study provides the first large, real-world analysis of the total direct medical costs of treating VTE in-hospital. It confirms that, despite higher drug acquisition costs, LMWH is cost-saving compared with UFH in the inpatient setting, and is associated with a lower VTE readmission rate at 30 and 90 days than is UFH.
Merli
G
G
Jefferson Center for Vascular Diseases, Thomas Jefferson University, Philadelphia, PA, USA. geno.merli@jefferson.edu
Ferrufino
C
C
Lin
J
J
Hussein
M
M
Battleman
D
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000191:economics / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006493:Heparin / Q000191:economics / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000191:economics / Q000627:therapeutic use; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000191:economics*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D006493:Heparin