title: Management of venous thromboembolism in cancer patients: the economic burden of hospitalizations.
abstract: Venous thromboembolism (VTE) is one of the most frequent events associated with cancer, requiring hospitalization and generating additional healthcare costs. To date, no studies analyzing the additional costs resulting from VTE associated with cancer in France have been published. The objective of this study was to provide an estimation of the additional cost induced by VTE with cancer by analyzing hospital stays reported in the 2013 PMSI French Hospital Database ("Programme de Médicalisation des Systèmes d'Information", a national hospital administrative database) for four cancer types (breast, lung, hepatocellular carcinoma, and colon).
  
  
  
  The analysis is divided into three parts: a descriptive evaluation of hospitalizations for VTE with cancer, an analysis by severity level of diagnosis-related groups (DRG), and an estimation of the hospital costs based on the National Reference Costs (ENC). The French public ATIH ("Agence Technique de l'Information sur l'Hospitalisation", a national Agency for Data on Hospital Care) database was used. The critical approach of this study is based on analysis of the distribution of stays according to levels of severity of DRG.
  
  
  
  A total of 14,251 hospitalizations were analyzed combining VTE and cancer. Hospitalizations of the two highest levels of severity (levels 3 and 4) for VTE with cancer represented 81.7 % of all hospitalizations in this population. Increased costs were seen for all four cancer types evaluated, with cost coefficients ranging from 1.34 to 2.01. For example, the average cost of lung cancer in cancer patients with VTE in the PMSI database was 7296 € versus 4647 € in the ATIH database. Cost coefficients were calculated, ranging from 1.34 in colon cancer, 1.50 for breast cancer, 1.57 in lung cancer, and 2.01 for hepatocellular carcinoma.
  
  
  
  As discussed in the article, the current costs are high. Better physician adherence to clinical practice guidelines could potentially reduce these costs by lowering the number of recurrent VTE in patients with cancer.
authors.affiliation: Internal Medicine Department, Louis Mourier Hospital, APHP, Paris 7 University, Colombes, France. Isabelle.mahe@aphp.fr.|EA 7334 Université Paris Diderot, Sorbonne Paris Cité, Paris, France. Isabelle.mahe@aphp.fr.|Intergroupe AFSOS-UNICANCER, Paris, France. Isabelle.mahe@aphp.fr.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Mahé
authors.affiliation: Oncology Department, Mignot Hospital, 177, rue de Versailles, 78 157, Le Chesnay Cedex, France.|Intergroupe AFSOS-UNICANCER, Paris, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Mayeur
authors.affiliation: Oncology Support Care Department, Bergonié Institute, 229 Cours de l'Argonne CS 61283, 33076, Bordeaux Cedex, France.|Intergroupe AFSOS-UNICANCER, Paris, France.
authors.forename: Ivan
authors.initials: I
authors.lastname: Krakowski
mesh_terms: D000368:Aged; D005260:Female; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000473:pathology; D054556:Venous Thromboembolism / Q000628:therapy*
keywords: Cancer; Economic burden; Hospitalization; Venous thromboembolism