Home Treatment Compared to Initial Hospitalization in Normotensive Patients with Acute Pulmonary Embolism in the Netherlands: A Cost Analysis

Stephan V. Hendriks; Wilbert B. van den Hout; Thomas van Bemmel; Ingrid M. Bistervels; Michiel Eijsvogel; Laura M. Faber; Herman M. A. Hofstee; Tom van der Hulle; Antonio Iglesias del Sol; Marieke J. H. A. Kruip; Albert T. A. Mairuhu; Saskia Middeldorp; Mathilde Nijkeuter; Menno V. Huisman; Frederikus A. Klok; for the YEARS Investigators

doi:10.1055/a-1518-1847

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2022; 122(03): 427-433
DOI: 10.1055/a-1518-1847

Stroke, Systemic or Venous Thromboembolism

Home Treatment Compared to Initial Hospitalization in Normotensive Patients with Acute Pulmonary Embolism in the Netherlands: A Cost Analysis

Stephan V. Hendriks

¹Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands

²Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands

,

Wilbert B. van den Hout

³Department of Biomedical Data Science-Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands

,

Thomas van Bemmel

⁴Department of Internal Medicine, Gelre Hospital, Apeldoorn, The Netherlands

,

Ingrid M. Bistervels

⁵Department of Internal Medicine, Flevoziekenhuis, Almere, The Netherlands

⁶Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

,

Michiel Eijsvogel

⁷Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands

,

Laura M. Faber

⁸Department of Internal Medicine, Rode Kruis Hospital, Beverwijk, The Netherlands

,

Herman M. A. Hofstee

⁹Department of Internal Medicine, Haaglanden Medisch Centrum, The Hague, The Netherlands

,

Tom van der Hulle

¹Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands

,

Antonio Iglesias del Sol

¹⁰Department of Internal Medicine, Alrijne Hospital, Leiderdorp, The Netherlands

,

Marieke J. H. A. Kruip

¹¹Department of Haematology, Erasmus University Medical Center, Rotterdam, The Netherlands

,

Albert T. A. Mairuhu

²Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands

,

Saskia Middeldorp

⁶Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

,

Mathilde Nijkeuter

¹²Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands

,

Menno V. Huisman

¹Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands

,

Frederikus A. Klok

¹Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands

,

for the YEARS Investigators

› Author Affiliations

Abstract

Background Venous thromboembolism constitutes substantial health care costs amounting to approximately 60 million euros per year in the Netherlands. Compared with initial hospitalization, home treatment of pulmonary embolism (PE) is associated with a cost reduction. An accurate estimation of cost savings per patient treated at home is currently lacking.

Aim The aim of this study was to compare health care utilization and costs during the first 3 months after a PE diagnosis in patients who are treated at home versus those who are initially hospitalized.

Methods Patient-level data of the YEARS cohort study, including 383 normotensive patients diagnosed with PE, were used to estimate the proportion of patients treated at home, mean hospitalization duration in those who were hospitalized, and rates of PE-related readmissions and complications. To correct for baseline differences within the two groups, regression analyses was performed. The primary outcome was the average total health care costs during a 3-month follow-up period for patients initially treated at home or in hospital.

Results Mean hospitalization duration for the initial treatment was 0.69 days for those treated initially at home (n = 181) and 4.3 days for those initially treated in hospital (n = 202). Total average costs per hospitalized patient were €3,209 and €1,512 per patient treated at home. The adjusted mean difference was €1,483 (95% confidence interval: €1,181–1,784).

Conclusion Home treatment of hemodynamically stable patients with acute PE was associated with an estimated net cost reduction of €1,483 per patient. This difference underlines the advantage of triage-based home treatment of these patients.

Keywords

costs - home treatment - hospitalization - pulmonary embolism

Full Text

References

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Supplementary Material