Economic Burden and Cost Determinants of Deep Venous Thrombosis During the Two Years Following Diagnosis: a Prospective Evaluation

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 566-566
Author(s):  
Raphael Guanella ◽  
Thierry Ducruet ◽  
Mira Johri ◽  
Marie Jose Miron ◽  
Andre Roussin ◽  
...  

Abstract Abstract 566 Background and objectives: Deep venous thrombosis (DVT) is a common and serious vascular condition that is frequently complicated by the chronic post-thrombotic syndrome. Costs of DVT may occur over a long period and may be medical and non-medical in nature. During a Canadian multicenter cohort study of the long-term outcomes after DVT (The Venous Thrombosis Outcomes [VETO] Study), we prospectively quantified resource use and costs related to DVT during two years after DVT diagnosis, and identified clinical determinants of costs. Methods: The study population consisted of 355 consecutive patients diagnosed with objectively confirmed acute DVT at one of 7 participating hospitals in the province of Quebec, Canada. Using a societal perspective, we tracked total medical resource use (hospitalizations, physician visits, other health professional visits, medications, ambulance services, stockings, assistive devices) and non-medical resource use (loss of productivity, home care, transportation) incurred by DVT during the 2 years after diagnosis. Data sources included weekly patient-completed cost diaries, nurse-completed case report forms (baseline, 1, 4, 8, 12, 24 months and at any DVT-related clinical event) and the Quebec provincial administrative healthcare database (“RAMQ”). Resources for each patient were valued using individual patient level information obtained from RAMQ and patient diaries. Statistics Canada data, provincial health professionals associations and local suppliers were used to estimate resource costs if individual information was not available. The value of lost productivity was estimated using a friction-cost approach. Multivariate regression modeling for predictors of medical costs during 2 years included baseline demographic and clinical characteristics as well as the development of post-thrombotic syndrome (PTS) during study follow-up. Results: At study entry, mean age was 56.5 years, 50.1% were male, 2/3 were out-patients and 58.0% had proximal DVT. The mean duration of heparin and warfarin treatment was 7.6 days (SD 6.0) and 21.6 weeks (SD 10.0), respectively. During 2 years follow-up, the rate of DVT-related hospitalization was 3.5 per 100 patient-years (95% CI 2.2, 4.9). Patients reported, on average, 15.0 (SD 14.5) physician visits and 0.7 (SD 1.2) non-physician visits. Patients required 12.7 (SD 9.2) transportations, 38.6 (SD 138.0) hours of assistance and missed 12.1 (SD 39.8) workdays. The average per-patient total cost over 2 years was Can$4109 (95% CI $3658, $4561) with 63.7% of costs attributable to non-medical resource use. The two largest medical cost components were hospitalizations (Can$502; 95% CI $261, $744) and physician visits (Can$356; 95% CI $320, $392). More than two-thirds of all resource consumption occurred during the first 4 months after diagnosis. In multivariate analysis focusing on determinants of medical costs, concomitant pulmonary embolism (p = 0.002), idiopathic DVT (p= 0.003), and development of post-thrombotic syndrome during follow-up (p= 0.002) were independently associated with increased costs. Conclusion: The economic burden of DVT over the two years following initial diagnosis is substantial with almost two-thirds of costs attributable to non-medical resource use. Concomitant pulmonary embolism, idiopathic DVT, and development of PTS are important predictors of medical costs after DVT. Better adherence to thromboprophylaxis strategies and use of measures to prevent occurrence of PTS have the potential to diminish costs and resource utilization related to DVT. Disclosures: No relevant conflicts of interest to declare.

Vascular ◽  
2021 ◽  
pp. 170853812110209
Author(s):  
Rae S Rokosh ◽  
Jack H Grazi ◽  
David Ruohoniemi ◽  
Eugene Yuriditsky ◽  
James Horowitz ◽  
...  

Objectives Venous thromboembolism, including deep venous thrombosis and pulmonary embolism, is a major source of morbidity, mortality, and healthcare utilization. Given the prevalence of venous thromboembolism and its associated mortality, our study sought to identify factors associated with loss to follow-up in venous thromboembolism patients. Methods This is a single-center retrospective study of all consecutive admitted (inpatient) and emergency department patients diagnosed with acute venous thromboembolism via venous duplex examination and/or chest computed tomography from January 2018 to March 2019. Patients with chronic deep venous thrombosis and those diagnosed in the outpatient setting were excluded. Lost to venous thromboembolism-specific follow-up (LTFU) was defined as patients who did not follow up with vascular, cardiology, hematology, oncology, pulmonology, or primary care clinic for venous thromboembolism management at our institution within three months of initial discharge. Patients discharged to hospice or dead within 30 days of initial discharge were excluded from LTFU analysis. Statistical analysis was performed using STATA 16 (College Station, TX: StataCorp LLC) with a p-value of <0.05 set for significance. Results During the study period, 291 isolated deep venous thrombosis, 25 isolated pulmonary embolism, and 54 pulmonary embolism with associated deep venous thrombosis were identified in 370 patients. Of these patients, 129 (35%) were diagnosed in the emergency department and 241 (65%) in the inpatient setting. At discharge, 289 (78%) were on anticoagulation, 66 (18%) were not, and 15 (4%) were deceased. At the conclusion of the study, 120 patients (38%) had been LTFU, 85% of whom were discharged on anticoagulation. There was no statistically significant difference between those LTFU and those with follow-up with respect to age, gender, diagnosis time of day, venous thromboembolism anatomic location, discharge unit location, or anticoagulation choice at discharge. There was a non-significant trend toward longer inpatient length of stay among patients LTFU (16.2 days vs. 12.3 days, p = 0.07), and a significant increase in the proportion of LTFU patients discharged to a facility rather than home ( p = 0.02). On multivariate analysis, we found a 95% increase in the odds of being lost to venous thromboembolism-specific follow-up if discharged to a facility (OR 1.95, CI 1.1–3.6, p = 0.03) as opposed to home. Conclusions Our study demonstrates that over one-third of patients diagnosed with venous thromboembolism at our institution are lost to venous thromboembolism-specific follow-up, particularly those discharged to a facility. Our work suggests that significant improvement could be achieved by establishing a pathway for the targeted transition of care to a venous thromboembolism-specific follow-up clinic.


1999 ◽  
Vol 82 (10) ◽  
pp. 1222-1226 ◽  
Author(s):  
W. Åberg ◽  
D. Lockner ◽  
C. Paul ◽  
M. Holmström

SummaryThe primary objective of this retrospective study was to describe the frequency of a post-thrombotic syndrome in 265 patients previously treated for deep venous thrombosis (DVT). The secondary objectives were to document the frequency of recurrent venous thromboembolism (VTE) and mortality, especially from malignant disease. The patients were evaluated 5-14 years after inclusion in three randomized trials comparing continuous intravenous (i. v.) infusion of unfractionated heparin (UFH) (n = 85) with a low molecular weight heparin (LMWH), dalteparin (n = 180). The median post-thrombotic score at follow-up was 2 (range 0-8). In a multiple step-wise regression analysis the post-thrombotic score was significantly higher among patients with initial proximal DVT (p = 0,0001) as compared with those who had distal DVT. A recurrent venous thromboembolic event was diagnosed in 29,4% of the patients treated with dalteparin and in 23,5% of the patients treated with UFH (ns). A secondary risk factor for venous thromboembolism and a longer duration of treatment with oral anticoagulants (OAC) were significantly associated with a lower risk for recurrent VTE, whereas malignant disease diagnosed during follow-up was associated with a higher risk. During follow-up a total of 40,7% of patients had died. No difference in total mortality or mortality from malignant disease was demonstrated between the two drugs. In conclusion, a severe post-thrombotic syndrome occured relatively infrequent. considering the long observation period. Proximal DVT was significantly associated with a more severe post-thrombotic syndrome. After 14 years follow-up, no significant differences were observed in overall mortality, mortality from malignant disease or recurrent VTE between UFH- and dalteparin-treated patients. Malignant disease was a risk factor for recurrent VTE, the presence of a secondary risk factor and a longer duration of treatment with OAC decreased the risk for recurrent VTE.


Author(s):  
Zubin Irani ◽  
Sara Zhao

Lower extremity deep venous thrombosis (DVT) may be complicated by pulmonary embolism, post-thrombotic syndrome, and phlegmasia cerulea dolens. Due to these complications, the American Venous Forum now recommends thrombus removal for large or symptomatic thrombus burden. The AngioJet Solent Proxy and Omni thrombectomy sets are indicated for use in iliofemoral and lower extremity veins with a diameter ≥3 mm. The device has quickly become a preferred device among the available mechanical thrombectomy options. The AngioJet system has been demonstrated as both efficacious and safe as a method of thrombectomy in lower extremity DVT. This chapter discusses two techniques to utilize the AngioJet device in iliofemoral DVT.


Author(s):  
Viola Hach-Wunderle ◽  
Rupert Bauersachs ◽  
Horst-Eberhard Gerlach ◽  
Sonja Eberle ◽  
Sebastian Schellong ◽  
...  

2005 ◽  
Vol 13 (2) ◽  
pp. 113-119 ◽  
Author(s):  
OS Schindler ◽  
R Dalziel

Purpose. To measure the risk of developing signs of post-thrombotic syndrome 15 to 24 months after total hip or knee arthroplasty in patients with asymptomatic deep venous thrombosis (DVT). Methods. A total of 85 total knee arthroplasty patients and 47 total hip arthroplasty patients were postoperatively screened for asymptomatic DVT using colour duplex ultrasound. Results. The rate of asymptomatic DVT was 37.6% (n=32) in knee patients and 34.0% (n=16) in hip patients. All 32 DVT cases in the knee group had thrombi located below the knee, whereas 6 of the 16 DVT cases in the hip group had thrombi located above the knee, the remaining 10 were below the knee. Patients with proximal thrombi were treated with warfarin for 3 months, whereas patients with distal DVT received 300 mg aspirin daily for the same period. All DVT cases were monitored for up to 12 weeks using repeated colour duplex scans. Signs of thrombus resolution were present at around 6 weeks (range, 4–12 weeks). Clot propagation was observed in 3 cases. In a mean of postoperative 18 months (range, 15–24 months), 28 of the 32 knee patients with asymptomatic DVT were available for follow-up: 11 had transient calf and ankle swelling, 6 had persistent oedema, and the remaining 11 were symptom free. 14 of the 16 hip patients with asymptomatic DVT were available for follow-up: 6 had transient calf and ankle swelling, 4 had persistent oedema, and 4 remained symptom free. 17 patients reported ongoing problems and were re-examined. Signs of mild-to-moderate post-thrombotic syndrome were recorded in 4 knee patients and 3 hip patients. Conclusions. Patients with above-knee DVT were much more likely to have post-thrombotic syndrome. Despite thromboprophylaxis with low-molecular-weight heparin, asymptomatic DVT is common after total joint arthroplasty and is responsible for the development of post-thrombotic venous insufficiency and post-thrombotic syndrome in a considerable proportion of patients. Once symptomatic or asymptomatic DVT is established, treatment appears incapable of preventing the occurrence of post-thrombotic syndrome, especially in cases of above-knee DVT. Efforts should hence concentrate on combating DVT propagation and improving DVT prevention.


Phlebologie ◽  
2016 ◽  
Vol 45 (04) ◽  
pp. 253-255
Author(s):  
D. Mühlberger ◽  
P. Regeniter ◽  
A. Mumme ◽  
T. Hummel ◽  
B. Burkert

SummaryThe case reported here involves a 72-year-old female patient with right-sided popliteal vein aneurysm, which became apparent during follow-up ultrasound scanning after deep venous thrombosis of the left leg with pulmonary embolism. Due to the size of the aneurysm, the decision was made to perform surgery. The aneurysm was tangentially resected by means of plication. Aneurysms of the deep venous system carry a considerable risk of a thromboembolic event and therefore require treatment, even when they are asymptomatic. Surgical treatment of an aneurysm of the deep leg veins is a safe and low-risk procedure for the prevention of pulmonary embolism.


2014 ◽  
Vol 10 (5) ◽  
pp. 305 ◽  
Author(s):  
Noam Y. Kirson, PhD ◽  
Amie Shei, PhD ◽  
Howard G. Birnbaum, PhD ◽  
Rami Ben-Joseph, PhD ◽  
Edward Michna, MD

Objective: To estimate excess medical resource use and costs associated with prescription opioid (RxO) tolerability issues.Design: This was an observational, retrospective analysis of deidentified administrative claims data.Setting: The study included commercially insured patients treated in different healthcare settings captured in the Truven MarketScan claims database.Patients: Patients aged 18-64 years initiating treatment with an RxO (index) and continuously treated with pain relievers over a 6-month period were selected. “Switchers” were patients who discontinued their index RxO and switched to non-RxO pain relievers <30 days post-index, and whose last pain reliever in the 6-month follow-up period was not an RxO. Such switching was considered a proxy for RxO-tolerability issues. “Continuous RxO users” were patients who remained on the index RxO for the follow-up period. Switchers and continuous RxO users were matched 1:1 on propensity score, baseline medical costs, index RxO days supply, and short-/long-acting index RxO.Main Outcome Measures: Six-month follow-up medical resource use and costs were compared between matched switchers and continuous RxO users.Results: A total of 10,704 pairs of switchers and continuous RxO users were matched. In the 6-month follow-up period, switchers had more outpatient (7.5 vs 6.8; p < 0.001) and inpatient (0.05 vs 0.04; p = 0.002) visits and longer inpatient stays (0.26 days vs 0.19; p = 0.006) compared to continuous RxO users. Switchers also had higher total medical costs ($4,522 vs $3,657; p < 0.001).Conclusions: Switchers incur greater medical resource use and costs than similar patients continuously treated with their index RxO.  


2004 ◽  
Vol 92 (08) ◽  
pp. 328-336 ◽  
Author(s):  
Manuel Labiós ◽  
Olga Portolés ◽  
Marisa Guillén ◽  
Dolores Corella ◽  
Francesc Francés ◽  
...  

SummaryPost-thrombotic syndrome (PTS) is a frequent complication of deep venous thrombosis (DVT). However, neither the incidence nor the moment of PTS appearance are known. The main reason are the criteria used to define PTS, the characteristics of the patients, the study design and the time of follow-up. Our aims were to estimate the early incidence of PTS and its associated factors in a cohort of carefully defined DVT patients. 135 patients with a previous episode of acute idiopathic, phlebographically confirmed DVT, in the lower limbs, were followed up over 12 months. Phlebography was then repeated to determine the appearance of PTS. In addition, we used a validated clinical scale in order to assess the correlation between the clinical and phlebographical diagnosis of the PTS. This scale was applied at 6 and 12 months. The incidence of phlebographically confirmed PTS within the first year was 56.3% for the isolated PTS and 5.9% for PTS plus recurrent DVT, regardless of age, sex, platelet count, INR, or anticoagulation. None of these patients could be diagnosed as having PTS using the clinical validated scale. However, those patients with phlebographically diagnosed PTS had a higher clinical score than those without (P = 0.012). The only factor related to a higher risk of developing a PTS was the localization of the DVT, subjects with both proximal and distal DVT having the highest incidence (P = 0.001). In conclusion, although patients had appropriate anticoagulation, early incidence of PTS was very high, thus making it necessary to develop better diagnostic methods in order to evaluate the PTS impact.


2018 ◽  
Vol 7 ◽  
pp. 204800401876680 ◽  
Author(s):  
Christina P Madsen ◽  
Jerzy Gesla ◽  
Radu L Vijdea ◽  
Maria A Serifi ◽  
Johnny K Christensen ◽  
...  

Background Catheter-directed thrombolysis may prevent post-thrombotic syndrome in patients with ilio-femoral deep venous thrombosis. We performed a retrospective review of prospectively collected follow-up data to evaluate the results of catheter-directed thrombolysis at our institution. Method Patients admitted for venous thrombolysis were included in the study and their files screened for information regarding results and technical aspects of treatment and patient status on follow-up. A catheter was inserted under imaging guidance into the thrombosed vein. Through the catheter tissue plasminogen activator was administered. Daily catheter-based venographies were performed to monitor progression in thrombus resolution. After thrombolysis flow-limiting stenosis was stented. Patients started wearing compression stockings and were started on oral anticoagulant therapy. Follow-up visits with ultrasound, magnetic resonance venography and clinical assessment were scheduled at six weeks and three, six, 12 and 24 months. Results A total of 48 patients underwent catheter-directed thrombolysis, including 36 female patients. Median age was 28 years. Complete lysis of the thrombus was achieved in 43 cases and partial lysis in two cases and 26 stents were placed. No deaths or life-threatening bleeding events occurred. Thirty-two of the patients who achieved full lysis and were followed up remained patent at follow-up. At 12 months seven patients had symptoms of post-thrombotic syndrome. Conclusion Catheter-directed thrombolysis represents a safe and effective alternative to systemic anticoagulative treatment of deep venous thrombosis with rapid resolution of the thrombus and few complications. Long-term patency shows good validity and this study suggests that catheter-directed thrombolysis is effective in preventing post-thrombotic syndrome.


Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1821-1821 ◽  
Author(s):  
Jennifer Latella ◽  
Sylvie Desmarais ◽  
Susan Kahn ◽  

Abstract Background: The pathophysiology of the post-thrombotic syndrome (PTS) is postulated to involve persistent venous thrombosis and valvular reflux. We prospectively studied if d-dimer levels or valvular reflux were associated with subsequent development of the PTS after objectively confirmed deep venous thrombosis (DVT). Methods: Consecutive patients with objectively diagnosed acute symptomatic DVT were recruited at 8 hospital centres in Quebec and Ontario, Canada. Patients attended study visits at Baseline, 1, 4, 8, 12, and 24 months. Blood was taken to measure d-dimer (VIDAS d-dimer; cut off &lt;500 ug/L) at the 4 month visit. A standardized ultrasound assessment for popliteal venous valvular reflux was performed at the 12 month visit. Standardized assessments for PTS (using Villalta scale) were performed at each follow-up visit. Subjects were classified as having developed PTS if the ipsilateral Villalta score was &gt;5 on at least 2 visits starting at the 4 month visit or later or was &gt;5 at the final follow-up visit. Statistical analyses assessed associations between d-dimer level, ipsilateral reflux and PTS. Results: 387 patients were recruited and followed. Mean age was 56 years and 51% were male. PTS developed in 45% of patients. Mean d-dimer was significantly higher in patients who developed PTS compared with those who did not (712.0 vs. 444.0 ug/L; p= 0.02). In logistic regression analyses adjusted for age and warfarin use at the time of d-dimer determination, d-dimer levels significantly predicted PTS (p=0.03). Ipsilateral venous valvular reflux was more frequent in patients with moderate/severe PTS than in patients with no PTS or mild PTS (65% vs. 40% vs. 43%, respectively; p=0.013). Finally, mean d-dimer was higher in patients who developed recurrent VTE during follow-up (n=31) than in those who did not (1126.8 vs. 514.9 ug/L; p=0.05), and d-dimer was an independent predictor of recurrent VTE (p=0.04) after adjustment for other known predictors of recurrence. Conclusion: D-dimer levels measured 4 months after DVT are associated with subsequent development of PTS and are predictive of VTE recurrence. Venous valvular reflux was associated with moderate/severe PTS. Further studies are required to assess whether d-dimer or valvular reflux may be useful in determining which patients are most at risk of developing PTS or severe PTS and who may thus benefit from preventive strategies.


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