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DOI: 10.1160/TH11-02-0132
Deep-vein thrombosis: A United States cost model for a preventable and costly adverse event
Publikationsverlauf
Received: 25. Februar 2011
Accepted after major revision: 19. Mai 2011
Publikationsdatum:
24. November 2017 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035024/201103/lookinside/thumbnails/10-1160-th11-02-0132-1.jpg)
Summary
Preventable venous thromboembolism (VTE) and “appropriate” type, dose, and duration of prophylaxis are emerging concepts. Contemporary definitions by key quality organisations, including the World Health Organization, have shifted towards “preventable” VTE being considered an adverse event or adverse drug event. A decision tree and cost model were developed to estimate the United States health care costs for total deep-vein thrombosis (DVT), total hospital-acquired DVT, and total “preventable” DVT. Annual cost ranges were obtained in 2010 US dollars for total ($7.5 to $39.5 billion), hospital-acquired ($5 to $26.5billion), and preventable ($2.5 to $19.5 billion) DVT costs. When the sensitivity analysis was applied – taking into consideration higher incidence rates and costs – annual US total, hospital-acquired, and “preventable” DVT costs ranged from $9.8 to $52 billion, $6.8 to $36 billion, and $3.4 to $27 billion, respectively.
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References
- 1 Goldhaber SZ. Preventing pulmonary embolism and deep vein thrombosis: a ‘call to action’ for vascular medicine specialists. J Thromb Haemost 2007; 5: 1607-1609.
- 2 Heit JA, O’Fallon WM, Petterson TM. et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study. Arch Intern Med 2002; 162: 1245-1248.
- 3 Heit JA, Cohen AT, Anderson FA. Jr et al. on behalf of the VTE Impact Assessment Group. Estimated annual number of incident and recurrent, non-fatal and fatal venous thromboembolism (VTE) events in the US. Blood (ASH Annual Meeting Abstracts) 2005; 106 Abstract 910.
- 4 Anderson FA, Jr Zayaruzny M, Heit JA. et al. Estimated annual number of US acute-care hospital inpatients meeting ACCP criteria for venous thromboembolism (VTE) prophylaxis. Blood (ASH Annual Meeting Abstracts) 2005; 106 Abstract 903.
- 5 Cohen AT, Agnelli G, Anderson FA. Jr et al. VTE Impact Assessment Group in Europe (VITAE). Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007; 98: 756-764.
- 6 Spencer FA, Emery C, Lessard D. et al. The Worcester Venous Thromboembolism Study: a population-based study of the clinical epidemiology of venous thromboembolism. J Gen Intern Med 2006; 21: 722-727.
- 7 Spencer FA, Lessard D, Emery C. et al. Venous thromboembolism in the outpatient setting. Arch Intern Med 2007; 167: 1471-1475.
- 8 Goldhaber SZ, Tapson VF. DVT FREE Steering Committee. A prospective registry of 5,451 patients with ultrasound-confirmed deep vein thrombosis. Am J Cardiol 2004; 93: 259-262.
- 9 Deitelzweig S, Lin J, Johnson BH. et al. Prevalence of venous thromboembolism in the USA: now and future. J Thromb Haemost. 2009 7. 02 Abstract OC-WE-018.
- 10 White RH. The epidemiology of venous thromboembolism. Circulation 2003; 107 (Suppl. 231) I4-8
- 11 Hirsh J, Hoak J. Management of deep vein thrombosis and pulmonary embolism. A statement for healthcare professionals. Council on Thrombosis (in consultation with the Council on Cardiovascular Radiology), American Heart Association. Circulation 1996; 93: 2212-2245.
- 12 US Department of Health and Human Services (HHS). Surgeon General’s call to action to prevent deep vein thrombosis and pulmonary embolism 2008. Available at: on-dvt-2008.pdf. Accessed February 14, 2011.
- 13 Shojania KG, Duncan BW, Mc Donald KM. et al., editors. Making health care safer: a critical analysis of patient safety practices. Evidence Report/Technology Assessment No. 43, AHRQ Publication No. 01-E058;. 2001. Rockville, MD: Agency for Healthcare Research and Quality.; Available at: psnet.ahrq.gov/resource.aspx?resourceID=1599. Accessed February 14, 2011.
- 14 Hacking NM, Hellewell A, Sadler P. Prevention of deep vein thrombosis and pulmonary embolus. Anaesth Intensive Care Med 2006; 7: 449-452.
- 15 Geerts WH, Bergqvist D, Pineo GF. et al. American College of Chest Physicians. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 (Suppl. 06) 381S-453S.
- 16 Collins R, Scrimgeour A, Yusuf S. et al. Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. Overview of results of randomized trials in general, orthopedic, and urologic surgery. N Engl J Med 1988; 318: 1162-1173.
- 17 Mismetti P, Laporte S, Darmon JY. et al. Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolism in general surgery. Br J Surg 2001; 88: 913-930.
- 18 Arnold DM, Kahn SR, Shrier I. Missed opportunities for prevention of venous thromboembolism: an evaluation of the use of thromboprophylaxis guidelines. Chest 2001; 120: 1964-1971.
- 19 Shackford SR, Rogers FB, Terrien CM. et al. A 10-year analysis of venous thromboembolism on the surgical service: the effect of practice guidelines for prophylaxis. Surgery 2008; 144: 3-11.
- 20 Mahan CE, Hussein MA, Amin AN. et al. Venous thromboembolism pharmacy intervention management program with an active, multifaceted approach reduces preventable venous thromboembolism and increases appropriate prophylaxis. Clin Appl Thromb Hemost. 2011 in press.
- 21 Maynard G, Stein J. Preventing hospital-acquired venous thromboembolism: a Guide for effective quality improvement. Agency for Healthcare Research and Quality (AHRQ) Publication No. 08–0075 August 2008.. Rockville, MD: AHRQ.; Available at: www.jointcommission.org/specifications_manual_for_national_hospital_inpatient_quality_measures/. Accessed February 14, 2011.
- 22 Yu HT, Dylan ML, Lin J. et al. Hospitals’ compliance with prophylaxis guidelines for venous thromboembolism. Am J Health Syst Pharm 2007; 64: 69-76.
- 23 Amin A, Stemkowski S, Lin J. et al. Thromboprophylaxis rates in US medical centers: success or failure?. J Thromb Haemost 2007; 5: 1610-1616.
- 24 Amin A, Stemkowski S, Lin J. et al. Appropriate thromboprophylaxis in hospitalized cancer patients. Clin Adv Hematol Oncol 2008; 6: 910-920.
- 25 Amin A, Spyropoulos AC, Dobesh P. et al. Are hospitals delivering appropriate VTE prevention? The venous thromboembolism study to assess the rate of thromboprophylaxis (VTE start). J Thromb Thrombolysis 2010; 29: 326-339.
- 26 The Joint Commission (TJC). Specifications Manual for National Hospital Inpatient Quality Measures. Available at: www.jointcommission.org/specifications_manual_for_national_hospitaLmpatient_quality_measures/. Accessed February 18, 2011.
- 27 National Quality Forum (NQF). NQF-Endorsed® Standards: NQF #0434 Deep vein thrombosis (DVT) prophylaxis. 2008 Available at: www.qualityforum.org/Measures_List.aspx#k=THROMBOSIS. Accessed February 14, 2011.
- 28 Centers for Medicare and Medicaid Services (CMS). Eliminating serious, preventable, and costly medical errors – Never events. 2006 Available at: www.cms.hhs.gov/apps/media/press/release.asp?Counter=1863. Accessed November 30, 2009.
- 29 Centers for Medicare and Medicaid Services (CMS). CMS proposes to expand quality program for hospital inpatient services in FY 2009. 2008 Available at: www.cms.hhs.gov/apps/media/press/release.asp?Counter=3041. Accessed November 30, 2009.
- 30 The Joint Commission on Accreditation of Healthcare Organizations. More Options for Hospital Core Measures Joint Commission Perspectives®. April 2009 29. 04 Available at: www.jointcommission.org/More_Options_for_Hospital_Core_Measures-Perspective_April_2009/. Accessed February 14, 2011.
- 31 Nebeker JR, Hurdle JF, Hoffman J. et al. Developing a taxonomy for research in adverse drug events: potholes and signposts. Proc AMIA Symp. 2001: 493-497.
- 32 Barach P, Small SD. Reporting and preventing medical mishaps: lessons from non-medical near miss reporting systems. Br Med J 2000; 320: 759-763.
- 33 Kohn LT, Corrigan JM, Donaldson MS. editors; Committee on Quality of Health Care in America, Institute of Medicine. To err is human: building a safer health system.. Washington, DC: National Academy Press; 2000. Executive summary available at: books.nap.edu/catalog/9728.html. Accessed February 14, 2011.
- 34 Leape LL. Error in medicine. J Am Med Assoc 1994; 272: 1851-1857.
- 35 Cullen DJ, Bates DW, Small SD. et al. The incident reporting system does not detect adverse drug events: a problem for quality improvement. Jt Comm J Qual Improv 1995; 21: 541-548.
- 36 WHO. WHO draft guidelines for adverse event reporting and learning systems.. Geneva: WHO; 2005. Available at: www.who.int/patientsafety/events/05/Reporting_Guidelines.pdf. Accessed February 14, 2011.
- 37 Institute of Medicine. Preventing medication errors: quality chasm series.. Washington, DC: National Academy Press; 2006. Report brief available at: www.iom.edu/Reports/2006/Preventing-Medication-Errors-Quality-Chasm-Series.aspx. Accessed February 14, 2011.
- 38 Institute for Safe Medication Practices (ISMP). Adverse drug events and potential adverse drug events. 2010 Available at: www.ismp.org/Tools/FrederickReporting.asp. Accessed February 14, 2011.
- 39 Institute for Healthcare Improvement (IHI). Intensive Care Unit (ICU) Adverse Event Trigger Tool (IHI tool).. Cambridge, MA: IHI; 2000. Available at www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare/Tools/ICUAdverseEventTriggerTool.htm. Accessed February 14, 2011.
- 40 Classen DC, Pestotnik SL, Evans S. et al. Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. J Am Med Assoc 1997; 277: 301-306.
- 41 Bates DW, Spell N, Cullen DJ. et al. The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group. J Am Med Assoc 1997; 277: 307-311.
- 42 Cundiff DK. Anticoagulation therapy for venous thromboembolism. Med-GenMed 2004; 6: 5.
- 43 Spyropoulos AC, Lin J. Direct medical costs of venous thromboembolism and subsequent hospital readmission rates: an administrative claims analysis from 30 managed care organizations. J Manag Care Pharm 2007; 13: 475-486.
- 44 Spyropoulos AC. Outpatient-based treatment protocols in the management of venous thromboembolic disease. Am J Manag Care 2000; 6 (Suppl. 20) S1034-1044.
- 45 Spyropoulos AC, Hurley JS, Ciesla GN. et al. Management of acute proximal deep vein thrombosis: pharmacoeconomic evaluation of outpatient treatment with enoxaparin vs inpatient treatment with unfractionated heparin. Chest 2002; 122: 108-114.
- 46 Prandoni P, Lensing AW, Cogo A. et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med 1996; 125: 1-7.
- 47 Heit JA, Mohr DN, Silverstein MD. et al. Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med 2000; 160: 761-768.
- 48 Ashrani AA, Heit JA. Incidence and cost burden of post-thrombotic syndrome. J Thromb Thrombolysis 2009; 28: 465-476.
- 49 Brandjes DP, Büller HR, Haijboer H. et al. Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet 1997; 349: 759-762.
- 50 Tick LW, Doggen CJ, Rosendaal FR. et al. Predictors of the post-thrombotic syndrome with non-invasive venous examinations in patients 6 weeks after a first episode of deep vein thrombosis. J Thromb Haemost 2010; 8: 2685-2692.
- 51 Kearon C, Kahn SR, Agnelli G. et al. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 (Suppl. 06) 454S-545S.
- 52 Kahn SR, Kearon C, Julian JA. et al Extended Low-intensity Anticoagulation for Thrombo-embolism (ELATE) Investigators. Predictors of the post-thrombotic syndrome during long-term treatment of proximal deep vein thrombosis. J Thromb Haemost 2005; 3: 718-723.
- 53 Kahn SR. The post-thrombotic syndrome: the forgotten morbidity of deep venous thrombosis. J Thromb Thrombolysis 2006; 21: 41-48.
- 54 Prandoni P, Lensing AW, Prins MH. et al. Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: a randomized, controlled trial. Ann Intern Med 2004; 141: 249-256.
- 55 Prandoni P, Frulla M, Sartor D. et al. Venous abnormalities and the post-throm-botic syndrome. J Thromb Haemost 2005; 3: 401-402.
- 56 Vedantham S. Interventional approaches to acute venous thromboembolism. Semin Respir Crit Care Med 2008; 29: 56-65.
- 57 Kahn S, Ginsberg JS. Relationship between deep venous thrombosis and the post-thrombotic syndrome. Arch Intern Med 2004; 164: 17-26.
- 58 Stain M, Schönauer V, Minar E. et al. The post-thrombotic syndrome: risk factors and impact on the course of thrombotic disease. J Thromb Haemost 2005; 3: 2671-2676.
- 59 Caprini JA, Botteman MF, Stephens JM. et al. Economic burden of long-term complications of deep vein thrombosis after total hip replacement surgery in the United States. Value Health 2003; 6: 59-74.
- 60 MacDougall DA, Feliu AL, Boccuzzi SJ. et al. Economic burden of deep-vein thrombosis, pulmonary embolism, and post-thrombotic syndrome. Am J Health Syst Pharm 2006; 63 (Suppl. 206) S5-15.
- 61 Creekmore FM, Oderda GM, Pendleton RC. et al. Incidence and economic implications of heparin-induced thrombocytopenia in medical patients receiving prophylaxis for venous thromboembolism. Pharmacotherapy 2006; 26: 1438-1445.
- 62 Baroletti S, Piovella C, Fanikos J. et al. Heparin-induced thrombocytopenia (HIT): clinical and economic outcomes. Thromb Haemost 2008; 100: 1130-1135.
- 63 Willey VJ, Bullano MF, Hauch O. et al. Management patterns and outcomes of patients with venous thromboembolism in the usual community practice setting. Clin Ther 2004; 26: 1149-1159.
- 64 Bullano MF, Willey V, Hauch O. et al. Longitudinal evaluation of health plan cost per venous thromboembolism or bleed event in patients with a prior venous thromboembolism event during hospitalization. J Manag Care Pharm 2005; 11: 663-673.
- 65 Amin AN, Lin J, Lenhart G, Schulman KL. Clinical and economic outcomes in patients at risk of venous thromboembolism receiving appropriate enoxaparin or unfractionated heparin prophylaxis. Thromb Haemost 2009; 102: 321-326.
- 66 O’Brien B, Levine M, Willan A. et al. Economic evaluation of outpatient treatment with low-molecular-weight heparin for proximal vein thrombosis. Arch Intern Med 1999; 159: 2298-2304.
- 67 Thomas EJ, Studdert DM, Newhouse JP. et al. Costs of medical injuries in Utah and Colorado. Inquiry 1999; 36: 255-264.
- 68 Johnson WG, Brennan TA, Newhouse JP. et al. The economic consequences of medical injuries. J Am Med Assoc 1992; 267: 2487-2492.
- 69 Phillips T, Stanton B, Provan A. et al. A study of the impact of leg ulcers on quality of life: financial, social, and psychologic implications. J Am Acad Dermatol 1994; 31: 49-53.
- 70 Avorn J, Winkelmayer WC. Comparing the costs, risks, and benefits of competing strategies for the primary prevention of venous thromboembolism. Circulation 2004; 110 (Suppl. 241) IV25-IV32.
- 71 Passman MA. Mandated quality measures and economic implications of venous thromboembolism prevention and management. Am J Surg 2010; 199 (Suppl. 01) S21-31.
- 72 Anderson FA, Jr Wheeler HB, Goldberg RJ. et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Arch Intern Med 1991; 151: 933-938.
- 73 Max W, Rice DP, Sung HY. et al. Valuing human life: estimating the present value of lifetime earnings, 2000. San Francisco: UC San Francisco: Center for Tobacco Control Research and Education; 2004. Available at http://escholarship.org/uc/item/82d0550k. Accessed February 14, 2011.
- 74 Halfhill TR. Tom’s inflation calculator (v7.5, 1997-2010). Available at: www.halfhill.com/inflation.html. Accessed February 14, 2011.
- 75 Bradley CJ, Yabroff KR, Dahman B. et al. Productivity costs of cancer mortality in the United States: 2000-2020. J Natl Cancer Inst 2008; 100: 1763-1770.
- 76 Ewen EF, Zhao L, Kolm P. et al. Determining the in-hospital cost of bleeding in patients undergoing percutaneous coronary intervention. J Interv Cardiol 2009; 22: 266-273.
- 77 Linkins LA, Choi PT, Douketis JD. Clinical impact of bleeding in patients taking oral anticoagulant therapy for venous thromboembolism: a meta-analysis. Ann Intern Med 2003; 139: 893-900.
- 78 Kiser TH, Burch JC, Klem PM. et al. Safety, efficacy, and dosing requirements of bivalirudin in patients with heparin-induced thrombocytopenia. Pharmacotherapy 2008; 28: 1115-1124.
- 79 Warkentin TE, Greinacher A, Koster A. et al. American College of Chest Physicians. Treatment and prevention of heparin-induced thrombocytopenia: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 (Suppl. 06) 340S-380S.
- 80 Hirsh J, Bauer KA, Donati MB. et al American College of Chest Physicians. Parenteral anticoagulants: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 (Suppl. 06) 141S-159S.
- 81 Lubenow N, Eichler P, Lietz T. et al. Hit Investigators Group. Lepirudin in patients with heparin-induced thrombocytopenia – results of the third prospective study (HAT-3) and a combined analysis of HAT-1, HAT-2, and HAT-3. J Thromb Haemost 2005; 3: 2428-2436.
- 82 Prandoni P, Noventa F, Ghirarduzzi A. et al. The risk of recurrent venous thromboembolism after discontinuing anticoagulation in patients with acute proximal deep vein thrombosis or pulmonary embolism. A prospective cohort study in 1,626 patients. Haematologica 2007; 92: 199-205.
- 83 National Safety Council. Injury Facts. 2006. edition. Itasca, IL: NSC Press; 2006
- 84 Amin A, Hussein M, Battleman D. et al. Appropriate VTE prophylaxis is associated with lower direct medical costs. Hosp Pract (Minneap). 2010; 38: 130-137.
- 85 Anderson FA, Jr Zayaruzny M, Heit JA. et al. Estimated annual numbers of US acute-care hospital patients at risk for venous thromboembolism. Am J Hematol 2007; 82: 777-782.
- 86 Hall MJ, DeFrances CJ, Williams SN. et al. National Hospital Discharge Survey: 2007 summary. National Health Statistics Reports 2010; 29: 1-20 24. Available at www.cdc.gov/nchs/data/nhsr/nhsr029.pdf. Accessed: February 18, 2011.
- 87 Bauer JB, Chun DS, Karpinski TA. Pharmacist-led program to improve venous thromboembolism prophylaxis in a community hospital. Am J Health Syst Pharm 2008; 65: 1643-1647.
- 88 Labarere J, Bosson JL, Sevestre MA. et al. Intervention targeted at nurses to improve venous thromboprophylaxis. Int J Qual Health Care 2007; 19: 301-308.
- 89 Sobieraj DM. Development and implementation of a program to assess medical patients’ need for venous thromboembolism prophylaxis. Am J Health Syst Pharm 2008; 65: 1755-1760.
- 90 Gilpin VL. Cost savings in quality improvement project to prevent venous thromboembolism. J Vasc Nurs 2007; 25: 70-74.
- 91 Kopp BJ, Mrsan M, Erstad BL. et al. Cost implications of and potential adverse events prevented by interventions of a critical care pharmacist. Am J Health Syst Pharm 2007; 64: 2483-2487.
- 92 Kucukarslan SN, Peters M, Mlynarek M. et al. Pharmacists on rounding teams reduce preventable adverse drug events in hospital general medicine units. Arch Intern Med 2003; 163: 2014-2018.
- 93 Kucher N, Koo S, Quiroz R. et al. Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med 2005; 352: 969-977.
- 94 Piazza G, Rosenbaum EJ, Pendergast W. et al. Physician alerts to prevent symptomatic venous thromboembolism in hospitalized patients. Circulation 2009; 119: 2196-2201.
- 95 The Leapfrog Group. Computerized physician order entry. Available at: www.leapfroggroup.org/for_hospitals/leapfrog_safety_practices/cpoe. Accessed April 22, 2011.
- 96 Agency for Healthcare Research and Quality. Inpatient computerized provider order entry (CPOE). Findings from the AHRQ health IT portfolio. Available at: healthit.ahrq.gov/images/jan09cpoereport/cpoe_issue_paper.htm. Accessed April 22, 2011.
- 97 Bates DW, Leape LL, Cullen DJ. et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. J Am Med Assoc 1998; 280: 1311-1316.