Appropriate VTE prophylaxis is associated with lower direct medical costs.
OBJECTIVE
To calculate and compare the direct medical costs of guideline-recommended prophylaxis with prophylaxis that does not fully adhere with guideline recommendations in a large, real-world population.


METHODS
Discharge records were retrieved from the US Premier Perspective™ database (January 2003-December 2003) for patients aged≥40 years with a primary diagnosis of cancer, chronic heart failure, lung disease, or severe infectious disease who received some form of thromboprophylaxis. Univariate analysis and multivariate regression modeling were performed to compare direct medical costs between discharges who received appropriate prophylaxis (correct type, dose, and duration based on sixth edition American College of Chest Physicians [ACCP] recommendations) and partial prophylaxis (not in full accordance with ACCP recommendations). Market segmentation analysis was used to compare costs stratified by hospital and patient characteristics.


RESULTS
Of the 683 005 discharges included, 148,171 (21.7%) received appropriate prophylaxis and 534,834 (78.3%) received partial prophylaxis. The total direct unadjusted costs were $15,439 in the appropriate prophylaxis group and $17,763 in the partial prophylaxis group. After adjustment, mean adjusted total costs per discharge were lower for those receiving appropriate prophylaxis ($11,713; 95% confidence interval [CI], $11,675-$11,753) compared with partial prophylaxis ($13,369; 95% CI, $13,332-$13 406; P<0.01). Appropriate prophylaxis appeared to be associated with numerically lower unadjusted costs than partial prophylaxis, regardless of hospital size, rural/urban location, teaching status, and patient age and gender.


CONCLUSIONS
This large, real-world analysis suggests that appropriate prophylaxis, in adherence with ACCP guidelines, is potentially cost-saving compared with partial prophylaxis in at-risk medical patients.
School of Medicine, University of California-Irvine, 101 The City Drive South, Building 58, Room 110, ZC-4076H, Orange, CA 92868, USA. anamin@uci.edu
Alpesh
A
Amin
Mohamed
M
Hussein
David
D
Battleman
Jay
J
Lin
Stephen
S
Stemkowski
Geno J
GJ
Merli
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000191:economics / Q000627:therapeutic use; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D004180:Direct Service Costs / Q000706:statistics & numerical data*; D016527:Drug Costs; D005260:Female; D019983:Guideline Adherence / Q000458:organization & administration; D006302:Health Services Research; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D008297:Male; D008389:Marketing of Health Services; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000191:economics*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*
D000925:Anticoagulants