title: Direct Medical Costs Attributable to Cancer-Associated Venous Thromboembolism: A Population-Based Longitudinal Study.
abstract: The purpose of this study is to estimate medical costs attributable to venous thromboembolism among patients with active cancer.
  
  
  
  In a population-based cohort study, we used Rochester Epidemiology Project (REP) resources to identify all Olmsted County, Minn. residents with incident venous thromboembolism and active cancer over the 18-year period, 1988-2005 (n = 374). One Olmsted County resident with active cancer without venous thromboembolism was matched to each case on age, sex, cancer diagnosis date, and duration of prior medical history. Subjects were followed forward in REP provider-linked billing data for standardized, inflation-adjusted direct medical costs from 1 year prior to index (venous thromboembolism event date or control-matched date) to the earliest of death, emigration from Olmsted County, or December 31, 2011, with censoring on the shortest follow-up to ensure a similar follow-up duration for each case-control pair. We used generalized linear modeling to predict costs for cases and controls and bootstrapping methods to assess uncertainty and significance of mean adjusted cost differences. Outpatient drug costs were not included in our estimates.
  
  
  
  Adjusted mean predicted costs were 1.9-fold higher for cases ($49,351) than for controls ($26,529) (P < .001) from index to up to 5 years post index. Cost differences between cases and controls were greatest within the first 3 months (mean difference = $13,504) and remained significantly higher from 3 months to 5 years post index (mean difference = $12,939).
  
  
  
  Venous thromboembolism-attributable costs among patients with active cancer contribute a substantial economic burden and are highest from index to 3 months, but may persist for up to 5 years.
authors.affiliation: Division of Cardiovascular Diseases and Gonda Vascular Center, Department of Internal Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Cohoon
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn.
authors.forename: Jeanine E
authors.initials: JE
authors.lastname: Ransom
authors.affiliation: Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Leibson
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Aneel A
authors.initials: AA
authors.lastname: Ashrani
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn.
authors.forename: Tanya M
authors.initials: TM
authors.lastname: Petterson
authors.affiliation: K Long Health Economics Consulting LLC, St. Paul, Minn.
authors.forename: Kirsten Hall
authors.initials: KH
authors.lastname: Long
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn.
authors.forename: Kent R
authors.initials: KR
authors.lastname: Bailey
authors.affiliation: Division of Cardiovascular Diseases and Gonda Vascular Center, Department of Internal Medicine, Mayo Clinic, Rochester, Minn; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn; Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minn. Electronic address: heit.john@mayo.edu.
authors.forename: John A
authors.initials: JA
authors.lastname: Heit
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D015897:Comorbidity; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D009369:Neoplasms / Q000150:complications / Q000191:economics*; D054556:Venous Thromboembolism / Q000191:economics* / Q000453:epidemiology / Q000209:etiology
keywords: Active cancer; Cost analysis; Cost of illness; Deep vein thrombosis; Medical care utilization; Pulmonary embolism; Venous thromboembolism