Cost-effectiveness of Venous Thromboembolism Prophylaxis After Hospitalization in Patients With Inflammatory Bowel Disease

2021 ◽  
Author(s):  
Kate E Lee ◽  
Francesca Lim ◽  
Jean-Frederic Colombel ◽  
Chin Hur ◽  
Adam S Faye
Keyword(s):  
Inflammatory Bowel Disease ◽  
Venous Thromboembolism ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Bowel Disease ◽  
Sensitivity Analyses ◽  
Vte Prophylaxis ◽  
Life Years ◽  
Increased Risk ◽  
Inflammatory Bowel

Abstract Background Patients with inflammatory bowel disease (IBD) have a 2- to 3-fold greater risk of venous thromboembolism (VTE) than patients without IBD, with increased risk during hospitalization that persists postdischarge. We determined the cost-effectiveness of postdischarge VTE prophylaxis among hospitalized patients with IBD. Methods A decision tree compared inpatient prophylaxis alone vs 4 weeks of postdischarge VTE prophylaxis with 10 mg/day of rivaroxaban. Our primary outcome was quality-adjusted life years (QALYs) over 1 year, and strategies were compared using a willingness to pay of $100,000/QALY from a societal perspective. Costs (in 2020 $USD), incremental cost-effectiveness ratios (ICERs) and number needed to treat (NNT) to prevent 1 VTE and VTE death were calculated. Deterministic 1-way and probabilistic analyses assessed model uncertainty. Results Prophylaxis with rivaroxaban resulted in 1.68-higher QALYs per 1000 persons compared with no postdischarge prophylaxis at an incremental cost of $185,778 per QALY. The NNT to prevent a single VTE was 78, whereas the NNT to prevent a single VTE-related death was 3190. One-way sensitivity analyses showed that higher VTE risk >4.5% and decreased cost of rivaroxaban ≤$280 can reduce the ICER to <$100,000/QALY. Probabilistic sensitivity analyses favored prophylaxis in 28.9% of iterations. Conclusions Four weeks of postdischarge VTE prophylaxis results in higher QALYs compared with inpatient prophylaxis alone and prevents 1 postdischarge VTE among 78 patients with IBD. Although postdischarge VTE prophylaxis for all patients with IBD is not cost-effective, it should be considered in a case-by-case scenario, considering VTE risk profile, costs, and patient preference.

scholarly journals P493 Cost-effectiveness of venous thromboembolism prophylaxis after hospitalization in patients with Inflammatory Bowel Disease

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S477-S477
Author(s):  
K Lee ◽  
F Lim ◽  
J F Colombel ◽  
C Hur ◽  
A Faye
Keyword(s):  
Venous Thromboembolism ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Sensitivity Analyses ◽  
Number Needed To Treat ◽  
Post Discharge ◽  
Vte Prophylaxis ◽  
Life Years ◽  
Increased Risk ◽  
Inflammatory Bowel

Abstract Background Patients with inflammatory bowel disease (IBD) have a 2- to 3-fold greater risk of venous thromboembolism (VTE) than the general population, with increased risk during hospitalization. However, recent evidence suggests that this increased risk persists post-discharge. As such, we aimed to determine the cost-effectiveness of post-discharge VTE prophylaxis among hospitalized patients with IBD. Methods A decision tree was used to compare inpatient prophylaxis alone versus 4 weeks of post-discharge VTE prophylaxis with rivaroxaban 10 mg/day. Our primary outcome was quality-adjusted life years (QALYs) over one year, and strategies were compared using a willingness to pay of $100,000/QALY from a societal perspective. Costs (in 2020 $US), incremental cost-effectiveness ratios (ICERs), and number needed to treat (NNT) to prevent one VTE and VTE death were calculated. Deterministic 1-way and probabilistic analyses were performed to assess uncertainty within the model. Results Four-week post-discharge prophylaxis with rivaroxaban resulted in 1.68 higher QALYs per 1000 persons and an incremental cost of $185,778 per QALY as compared to no post-discharge prophylaxis. The NNT to prevent a single VTE was 78 individuals, while the NNT to prevent a single VTE-related death was 3190 individuals. One-way sensitivity analyses showed that higher baseline VTE risk >4.5% or decreased cost of rivaroxaban ≤$280 can reduce the ICER to <$100,000/QALY. Probabilistic sensitivity analyses favored post-discharge prophylaxis in 26.5% of iterations. Abbreviations: QALY (Quality-Adjusted Life Years), ICER (Incremental Cost-Effectiveness Ratio), NNT (Number Needed to Treat), VTE (Venous Thromboembolism) Figure. Tornado diagram showing main drivers (variables and sensitivity ranges) of the incremental cost-effectiveness ratio (ICER). *Values represent threshold values that reduce the ICER to <$100,000/QALY. Abbreviations: VTE (Venous Thromboembolism), DVT (Deep Vein Thrombosis), PE (Pulmonary Embolism), PTS (Post-Thrombotic Syndrome), WTP (Willingness To Pay), EV (Expected Value) Conclusion Four weeks of post-discharge VTE prophylaxis results in higher QALYs as compared to inpatient prophylaxis alone, and can prevent one post-discharge VTE among 78 patients with IBD. As such, post-discharge VTE prophylaxis in patients with IBD should be considered in a case-by-case scenario considering VTE risk profile, costs, and patient preference.

scholarly journals Minor Hematochezia Decreases Use of Venous Thromboembolism Prophylaxis in Patients with Inflammatory Bowel Disease

2019 ◽  
Vol 26 (9) ◽  
pp. 1394-1400 ◽  
Author(s):  
Adam S Faye ◽  
Kenneth W Hung ◽  
Kimberly Cheng ◽  
John W Blackett ◽  
Anna Sophia Mckenney ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Venous Thromboembolism ◽  
Bowel Disease ◽  
Hospitalized Patients ◽  
High Yield ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Factors Associated ◽  
Increased Risk ◽  
Inflammatory Bowel

Abstract Background Despite increased risk of venous thromboembolism (VTE) among hospitalized patients with inflammatory bowel disease (IBD), pharmacologic prophylaxis rates remain low. We sought to understand the reasons for this by assessing factors associated with VTE prophylaxis in patients with IBD and the safety of its use. Methods This was a retrospective cohort study conducted among patients hospitalized between January 2013 and August 2018. The primary outcome was VTE prophylaxis, and exposures of interest included acute and chronic bleeding. Medical records were parsed electronically for covariables, and logistic regression was used to assess factors associated with VTE prophylaxis. Results There were 22,499 patients studied, including 474 (2%) with IBD. Patients with IBD were less likely to be placed on VTE prophylaxis (79% with IBD, 87% without IBD), particularly if hematochezia was present (57% with hematochezia, 86% without hematochezia). Among patients with IBD, admission to a medical service and hematochezia (adjusted odds ratio 0.27; 95% CI, 0.16–0.46) were among the strongest independent predictors of decreased VTE prophylaxis use. Neither hematochezia nor VTE prophylaxis was associated with increased blood transfusion rates or with a clinically significant decline in hemoglobin level during hospitalization. Conclusion Hospitalized patients are less likely to be placed on VTE prophylaxis if they have IBD, and hematochezia may drive this. Hematochezia appeared to be minor and was unaffected by VTE prophylaxis. Education related to the safety of VTE prophylaxis in the setting of minor hematochezia may be a high-yield way to increase VTE prophylaxis rates in patients with IBD.

scholarly journals Survey of Perceptions and Practices among Canadian Gastroenterologists regarding the Prevention of Venous Thromboembolism for Hospitalized Inflammatory Bowel Disease Patients

2012 ◽  
Vol 26 (11) ◽  
pp. 795-798 ◽  
Author(s):  
Roshan Razik ◽  
Charles N Bernstein ◽  
Justina Sam ◽  
Reka Thanabalan ◽  
Geoffrey C Nguyen
Keyword(s):  
Inflammatory Bowel Disease ◽  
Venous Thromboembolism ◽  
Bowel Disease ◽  
Demographic Data ◽  
Pharmacological Prophylaxis ◽  
Vte Prophylaxis ◽  
Clinical Scenarios ◽  
Increased Risk ◽  
Inflammatory Bowel ◽  
Preventable Complication

BACKGROUND: Patients with inflammatory bowel disease (IBD) who are hospitalized with disease flares are known to be at an increased risk of venous thromboembolism (VTE). This is a preventable complication; however, there is currently no standardized approach to the prevention and management of VTE.OBJECTIVES: To characterize the opinions and general prophylaxis patterns of Canadian gastroenterologists and IBD experts.METHODS: A survey questionnaire was sent to Canadian gastroenterologists affiliated with a medical school or IBD referral centre. Participants were required to be practicing physicians who had completed all of their training and had been involved in the care of IBD patients within the previous 12 months. Various clinical scenarios were presented and demographic data were solicited.RESULTS: The majority of respondents were practicing in an academic setting (95%) and considered themselves to be IBD experts or subspecialists (71%). Eighty-three per cent reported providing VTE prophylaxis most, if not all of the time, and most (96%) used pharmacological prophylaxis alone, usually heparin or one of its analogues. There was less consistency among respondents with respect to whether IBD patients in remission, but admitted for another condition, should be given prophylaxis. There was also less agreement regarding the duration of anticoagulation in patients with confirmed VTE.CONCLUSION: There was a general consensus among academic gastroenterologists that IBD inpatients are at an increased risk for VTE and would benefit from VTE prophylaxis. However, areas of uncertainty still exist and the IBD community would benefit from evidence-based clinical practice guidelines to standardize the management of this important problem.

730 INCREASED RISK OF VENOUS THROMBOEMBOLISM IN PAEDIATRIC-ONSET INFLAMMATORY BOWEL DISEASE - A STUDY OF THE INTERNATIONAL PROSPECTIVE SAFETY REGISTRY

2021 ◽  
Vol 160 (6) ◽  
pp. S-146
Author(s):  
Renz Klomberg ◽  
Martine Aardoom ◽  
Polychronis Kemos ◽  
Frank Ruemmele ◽  
C.H. (Heleen) Van Ommen ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Venous Thromboembolism ◽  
Bowel Disease ◽  
Increased Risk ◽  
Inflammatory Bowel

scholarly journals Cost-effectiveness of an Adjuvanted Hepatitis B Vaccine (HEPLISAV-B™) inPatients with Inflammatory Bowel Disease

2020 ◽  
Author(s):  
Juan E Corral ◽  
Joshua Y Kwon ◽  
Freddy Caldera ◽  
Surakit Pungpapong ◽  
Aaron C Spaulding ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Chronic Hepatitis ◽  
Cost Effectiveness ◽  
Hepatitis B ◽  
Acute Hepatitis ◽  
Bowel Disease ◽  
Sensitivity Analyses ◽  
Progression Rate ◽  
Old Patients ◽  
Inflammatory Bowel

Abstract Background Compare the cost-effectiveness of two recombinant hepatitis B vaccines (HBV) in patients with inflammatory bowel disease (IBD). Methods Markov models were developed for two IBD cohorts: A) 40-year-old patients prior to starting IBD treatment and B) 40-year-old patients already receiving therapy. Cohort A received full vaccination series, cohort B had primary vaccine failure and received a vaccine booster. Two vaccines were compared: adjuvanted HEPLISAV-B™ and nonadjuvanted Engerix-B®. Clinical probabilities of acute hepatitis, chronic hepatitis, cirrhosis, fulminant hepatic failure and death, treatment costs and effectiveness estimates were obtained from published literature. A lifetime analysis and a U.S. payer perspective were used. Probabilistic sensitivity analyses were performed for different hypothetical scenarios. Results Analysis of cohort A showed moderate cost-effectiveness of HEPLISAV-B™ ($88,114 per quality adjusted life-year [QALY]). Analysis of cohort B showed increased cost effectiveness ($35,563 per QALY). Changing Engerix-B® to HEPLISAV-B™ in a hypothetical group of 100,000 patients prevented 6 and 30 cases of acute hepatitis; and 4 and 5 cases of chronic hepatitis annually for cohort A and B respectively. It also prevented 1 and 2 cases of cirrhosis, and 1 and 2 deaths over 20 years for each cohort. Cost-effectiveness was determined by vaccination costs, patient age and progression rate from chronic hepatitis to cirrhosis. Conclusions HEPLISAV-B™ is cost-effective over Engerix-B® in patients receiving immunosuppressive therapy for IBD. Benefits increase with population aging and lower costs of vaccines. We advocate measuring protective level of HBV antibodies in patients with IBD and favor adjuvanted vaccines when vaccination is needed.

Abstract 16842: Cost-Effectiveness of Antibiotic-Eluting Envelopes for Prevention of Infections Associated With Cardiac Implantable Electronic Devices

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ronuk Modi ◽  
Peter Zimetbaum ◽  
Nicolas Isaza ◽  
Paola Calvachi ◽  
Inbar Raber ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Healthcare Costs ◽  
Electronic Devices ◽  
Sensitivity Analyses ◽  
Healthcare Sector ◽  
Term Survival ◽  
Cardiac Implantable Electronic Devices ◽  
Life Years ◽  
Increased Risk

Introduction: Infections of cardiac implantable electronic devices result in substantial morbidity and healthcare costs. Using an antibiotic-eluting envelope (AEE) during implantation may reduce the incidence of device-related infection. We examined the cost-effectiveness of an AEE in patients receiving CRT-D devices. Methods: This analysis was conducted independent of the trial sponsor. We developed a state-transition Markov model to compare the use of an AEE with usual care during CRT-D initial implantation or reimplantation. Effectiveness of the AEE (unit cost $1000) was estimated from the Worldwide Randomized Antibiotic Envelope Infection Prevention Trial. Other inputs were derived from prior trials, registries, vital statistics, and nationally representative datasets. Long-term survival was projected using a non-parametric approach. The model reported incidence of infections, mortality, quality-adjusted life years (QALYs), and direct healthcare costs. Future costs and QALYs were discounted by 3% annually. The primary outcome was the incremental cost-effectiveness ratio (ICER) of AEE use from the US healthcare sector perspective over a lifetime analytic horizon. We assumed a cost-effectiveness threshold of $100,000 per QALY gained. Results: Use of an AEE at initial CRT-D implantation added 0.008 QALYs per patient at an incremental cost of $918 (ICER $118,000/QALY). Due to higher infection rates, the use of AEE in reimplantation procedures was more economically attractive (ICER $55,900/QALY). One-way sensitivity analyses showed an inverse relationship between ICER and rate of infection. The ICER was less than $100,000/QALY with infection rate greater than 2.42% in the first year after new CRT-D (Figure 1). Conclusions: At current prices, use of AEE is cost-effective for CRT-D reimplantation procedures but not for initial CRT-D implants. Cost-effectiveness of AEEs may be improved by restricting use to patients at increased risk of infection.

scholarly journals The Risk of Rheumatoid Arthritis among Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Yi Chen ◽  
Lang Chen ◽  
Changsheng Xing ◽  
Guangtong Deng ◽  
Furong Zeng ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Inflammatory Bowel Disease ◽  
Cohort Studies ◽  
Bowel Disease ◽  
Meta Analysis ◽  
Sensitivity Analyses ◽  
Cross Sectional ◽  
Relative Risks ◽  
Increased Risk ◽  
Inflammatory Bowel

Abstract Background: Studies have suggested that patients with inflammatory bowel disease (IBD) have an increased risk of rheumatoid arthritis (RA). However, the available data on this association are inconsistent. This meta-analysis aimed to determine the association between IBD and the risk of RA. Methods: Observational studies investigating the RA risk among patients with IBD (Crohn disease (CD) and/or ulcerative colitis (UC)) were searched in PubMed, Embase, and Web of Science from the date of inception to December 2019 . The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. Relative risks (RRs) and corresponding 95% confidential intervals (CIs) were pooled with a random-effects model. Heterogeneity was evaluated using I 2 statistics while publication bias was determined using Begg’s and Egger’s tests. Subgroup and sensitivity analyses were performed. Results: A total of three cohort studies, three cross-sectional studies, and two case-control study were included in the meta-analyses. Compared to the non-IBD control or general population, there was a significantly higher risk of RA among patients with IBD (RR=2.59; 95% CI: 1.93–3.48). Moreover, both CD (RR=3.14; 95% CI: 2.46–4.01) and UC (RR=2.29; 95% CI: 1.76–2.97) were associated with a significantly increased risk of RA . However, heterogeneity was substantial across studies and the subgroup analyses failed to identify the potential source of heterogeneity. Conclusions: Patients with IBD have a greater risk of developing RA. Rheumatologists should be consulted when patients with IBD present with undifferentiated joint complaints. However, more prospective cohort studies are needed to validate these results.

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