European Union-28: An annualised cost-of-illness model for venous thromboembolism

Stefano Barco; Alex L. Woersching; Alex C. Spyropoulos; Franco Piovella; Charles E. Mahan

doi:10.1160/TH15-08-0670

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2016; 115(04): 800-808
DOI: 10.1160/TH15-08-0670

Stroke, Systemic or Venous Thromboembolism

Schattauer GmbH

European Union-28: An annualised cost-of-illness model for venous thromboembolism

Authors

Stefano Barco

¹Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, the Netherlands

²Center for Thrombosis and Hemostasis, Johannes Gutenberg University, University Medical Center Mainz, Germany
Alex L. Woersching

³Department of Health Services, School of Public Health, University of Washington, Seattle, Washington, USA
Alex C. Spyropoulos

⁴Anticoagulation and Clinical Thrombosis Services, North Shore-LIJ Health System; Professor of Medicine – Hofstra North Shore-LIJ School of Medicine, Manhasset, New York, USA
Franco Piovella

⁵Thromboembolic Disease Unit, Fondazione IRCCS Istituto Neurologico Nazionale Casimiro Mondino, Pavia, Italy
Charles E. Mahan

⁶Presbyterian Healthcare Services, University of New Mexico, Albuquerque, New Mexico, USA

Abstract

Summary

Annual costs for venous thromboembolism (VTE) have been defined within the United States (US) demonstrating a large opportunity for cost savings. Costs for the European Union-28 (EU-28) have never been defined. A literature search was conducted to evaluate EU-28 cost sources. Median costs were defined for each cost input and costs were inflated to 2014 Euros (€) in the study country and adjusted for Purchasing Power Parity between EU countries. Adjusted costs were used to populate previously published cost-models based on adult incidence-based events. In the base model, annual expenditures for total, hospital-associated, preventable, and indirect costs were €1.5–2.2 billion, €1.0–1.5 billion, €0.5–1.1 billion and €0.2–0.3 billion, respectively (indirect costs: 12 % of expenditures). In the long-term attack rate model, total, hospital-associated, preventable, and indirect costs were €1.8–3.3 billion, €1.2–2.4 billion, €0.6–1.8 billion and €0.2–0.7 billion (indirect costs: 13 % of expenditures). In the multiway sensitivity analysis, annual expenditures for total, hospital-associated, preventable, and indirect costs were €3.0–8.5 billion, €2.2–6.2 billion, €1.1–4.6 billion and €0.5–1.4 billion (indirect costs: 22 % of expenditures). When the value of a premature life-lost increased slightly, aggregate costs rose considerably since these costs are higher than the direct medical costs. When evaluating the models aggregately for costs, the results suggests total, hospital-associated, preventable, and indirect costs ranging from €1.5–13.2 billion, €1.0–9.7 billion, €0.5–7.3 billion and €0.2–6.1 billion, respectively. Our study demonstrates that VTE costs have a large financial impact upon the EU-28’s healthcare systems and that significant savings could be realised if better preventive measures are applied.

Keywords

Venous thromboembolism - annual costs - European Union - preventable costs - thromboprophylaxis

Full Text

References

References
1 ISTH Steering Committee for the World Thrombosis Day. Thrombosis: a major contributor to global disease burden. Thromb Haemost 2014; 112: 843-852.
2 Centers for Disease Control and Prevention (CDC). Venous thromboembolism in adult hospitalizations - United States, 2007-2009. MMWR Morb Mortal Wkly Rep 2012; 61: 401-404.
3 Deitelzweig SB, Johnson BH, Lin J. et al. Prevalence of clinical venous thromboembolism in the USA: current trends and future projections. Am J Hematol 2011; 86: 217-220.
4 Mahan CE, Borrego ME, Woersching AL. et al. Venous thromboembolism: An-nualised United States models for total, hospital-acquired and preventable costs utilising long-term attack rates. Thromb Haemost 2012; 108: 291-302.
5 Cohen AT, Agnelli G, Anderson FA. et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007; 98: 756-764.
6 Mahan CE, Holdsworth MT, Welch SM. et al. Deep-vein thrombosis: a United States cost model for a preventable and costly adverse event. Thromb Haemost 2011; 106: 405-415.
7 Naess IA, Christiansen SC, Romundstad P. et al. Incidence and mortality of venous thrombosis: a population-based study. J Thromb Haemost 2007; 5: 692-699.
8 Eurostat Statistics. EU-28 Population 15 and older. Accessed online via http://ec.europa.eu/eurostat/statistics-explained/index.php/File:Population_age_structure_by_major_age_groups,_2002_and_2012_-(%25_of_the_total_population)_YB14.png on October 4, 2015.
9 Eurostat Statistics. EU-28 Population. Accessed online via http://ec.europa.eu/eurostat/statistics-explained/index.php/Population_and_population_change_statistics on October 4, 2015.
10 Gomez-Outes A, Rocha E, Martinez-Gonzalez J. et al. Cost effectiveness of bemiparin sodium versus unfractionated heparin and oral anticoagulants in the acute and long-term treatment of deep vein thrombosis. Pharmacoeconomics 2006; 24: 81-92.
11 Chanel O, Henschel S, Goodman PG. et al. Economic valuation of the mortality benefits of a regulation on SO2 in 20 European cities. Eur J Public Health 2014; 24: 631-637.
12 Haentjens P, De Groote K, Annemans L. Prolonged enoxaparin therapy to prevent venous thromboembolism after primary hip or knee replacement. A cost-utility analysis. Arch Orthop Trauma Surg 2004; 124: 507-517.
13 Bjorvatn A, Kristiansen F. Fondaparinux sodium compared with enoxaparin sodium: a cost-effectiveness analysis. Am J Cardiovasc Drugs 2005; 5: 121-130.
14 Goodacre S, Sampson F, Stevenson M. et al. Measurement of the clinical and cost-effectiveness of non-invasive diagnostic testing strategies for deep vein thrombosis. Health Technol Assess 2006; 10: 1-168, iii-iv.
15 Santamaria A, Juarez S, Reche A. et al. Low-molecular-weight heparin, bemipa-rin, in the outpatient treatment and secondary prophylaxis of venous throm-boembolism in standard clinical practice: the ESFERA Study. Int J Clin Pract 2006; 60: 518-525.
16 Lundkvist J, Bergqvist D, Jonsson B. Cost-effectiveness of extended prophylaxis with fondaparinux compared with low molecular weight heparin against venous thromboembolism in patients undergoing hip fracture surgery. Eur J Health Econ 2007; 8: 313-323.
17 McBride D, Brüggenjürgen B, Roll S. et al. Management patterns of thrombosis prophylaxis and related costs in hip and knee replacement in Germany. Open Medicine. 2007: 2.
18 Elalamy I, Le Gal G, Nachit-Ouinekh F. et al. Heparin-induced thrombocytope-nia: an estimate of the average cost in the hospital setting in France. Clin Appl Thromb Hemost 2009; 15: 428-434.
19 McCullagh L, Tilson L, Walsh C. et al. A cost-effectiveness model comparing rivaroxaban and dabigatran etexilate with enoxaparin sodium as thrombopro-phylaxis after total hip and total knee replacement in the irish healthcare setting. Pharmacoeconomics 2009; 27: 829-846.
20 Ten Cate-Hoek AJ, Toll DB, Buller HR. et al. Cost-effectiveness of ruling out deep venous thrombosis in primary care versus care as usual. J Thromb Hae-most 2009; 7: 2042-2049.
21 Wilke T, Tesch S, Scholz A. et al. The costs of heparin-induced thrombocytope-nia: a patient-based cost of illness analysis. J Thromb Haemost 2009; 7: 766-773.
22 Wolowacz SE, Roskell NS, Maciver F. et al. Economic evaluation of dabigatran etexilate for the prevention of venous thromboembolism after total knee and hip replacement surgery. Clin Ther 2009; 31: 194-212.
23 Capri S, Ageno W, Imberti D. et al. Extended prophylaxis of venous throm-boembolism with fondaparinux in patients undergoing major orthopaedic surgery in Italy: a cost-effectiveness analysis. Intern Emerg Med 2010; 5: 33-40.
24 Norlin JM, Elf JL, Svensson PJ. et al. A cost-effectiveness analysis of diagnostic algorithms of deep vein thrombosis at the emergency department. Thromb Res 2010; 126: 195-199.
25 Wilkens H, Grimminger F, Hoeper M. et al. Burden of pulmonary arterial hypertension in Germany. Respir Med 2010; 104: 902-910.
26 Lecumberri R, Panizo E, Gomez-Guiu A. et al. Economic impact of an electronic alert system to prevent venous thromboembolism in hospitalised patients. J Thromb Haemost 2011; 9: 1108-1115.
27 Kroger K, Kupper-Nybelen J, Moerchel C. et al. Prevalence and economic burden of pulmonary embolism in Germany. Vasc Med 2012; 17: 303-309.
28 Migliaccio-Walle K, Rublee D, Simon TA. Anticoagulation prophylaxis in orthopedic surgery: an efficiency frontier approach. Postgrad Med 2012; 124: 41-49.
29 Postma MJ, Kappelhoff BS, van Hulst M. et al. Economic evaluation of dabi-gatran etexilate for the primary prevention of venous tromboembolic events following major orthopedic surgery in the Netherlands. J Med Econ 2012; 15: 878-886.
30 Italian Ministry of Health. Remunerazione delle prestazioni di assistenza os-pedaliera per acuti, assistenza ospedaliera di riabilitazione e di lungodegenza post acuzie e di assistenza specialistica ambulatoriale. Gazzetta Ufficiale. 2012: 23.
31 Zindel S, Stock S, Muller D. et al. A multi-perspective cost-effectiveness analysis comparing rivaroxaban with enoxaparin sodium for thromboprophylaxis after total hip and knee replacement in the German healthcare setting. BMC Health Serv Res 2012; 12: 192
32 Gussoni G, Foglia E, Frasson S. et al. Real-world economic burden of venous thromboembolism and antithrombotic prophylaxis in medical inpatients. Thromb Res 2013; 131: 17-23.
33 Monreal M, Folkerts K, Diamantopoulos A. et al. Cost-effectiveness impact of rivaroxaban versus new and existing prophylaxis for the prevention of venous thromboembolism after total hip or knee replacement surgery in France, Italy and Spain. Thromb Haemost 2013; 110: 987-994.
34 Santos IF, Pereira S, McLeod E. et al. Economic analysis of rivaroxaban for the treatment and long-term prevention of venous thromboembolism in Portugal. Acta Med Port 2014; 27: 615-624.
35 Department of Health (UK). NHS reference costs 2013 to 2014. Accessed online via https://www.gov.uk/government/publications/nhs-reference-costs-2013-to-2014 on October 4, 2015.
36 Relman A. A Second Opinion: Rescuing America’s Health Care (A Century Foundation Book). New York,: Public Affairs; 2007. p. 205.
37 Caraballo D, Spyropoulos AC, Mahan CE. Identifying, monitoring and reducing preventable major bleeds in the hospital setting. J Thromb Thrombolysis 2013; 36: 7-13.
38 US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. National Action Plan for Adverse Drug Event Prevention 2014. Accessed online via http://health.gov/hcq/pdfs/ADE-Action-Plan-508c.pdf on October 10, 2015.
39 Portola. Acute Medically Ill VTE Prevention With Extended Duration Betrixa-ban Study (The APEX Study) 2012. Accessed online via https://clinical-trials.gov/ct2/show/NCT01583218 on October 4, 2015.
40 Janssen. A Study of Rivaroxaban (JNJ-39039039) on the Venous Thromboem-bolic Risk in Post-Hospital Discharge Patients (MARINER) 2014. Accessed online via https://clinicaltrials.gov/ct2/show/NCT02111564?term=mari-ner&rank=1 on October 04, 2015.
41 Gould MK, Garcia DA, Wren SM. et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (Suppl. 02) e227S-77S.
42 Kahn SR, Lim W, Dunn AS. et al. Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (Suppl. 02) e195S-226S.
43 Burisch J, Jess T, Martinato M. et al. The burden of inflammatory bowel disease in Europe. J Crohns Colitis 2013; 7: 322-337.
44 Gibson GJ LR, Sibille Y, Lundbäck B. The European Lung White Book. Sheffield, European Respiratory Society. European Respiratory Society; 2013
45 Nichols M TN, Luengo-Fernandez R, Leal J. et al. European cardiovascular disease statistics 2012. European Heart Network, Brussels, European Society of Cardiology, Sophia Antipolis; 2012
46 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.
47 van Leent MW, Stevanovic J, Jansman FG. et al. Cost-Effectiveness of Dabi-gatran Compared to Vitamin-K Antagonists for the Treatment of Deep Venous Thrombosis in the Netherlands Using Real-World Data. PLoS One 2015; 10: e0135054
48 Lankeit M, Konstantinides S. Is it time for home treatment of pulmonary embolism?. Eur Respir J 2012; 40: 742-749.
49 Lefebvre P, Coleman CI, Bookhart BK. et al. Cost-effectiveness of rivaroxaban compared with enoxaparin plus a vitamin K antagonist for the treatment of venous thromboembolism. J Med Econ 2014; 17: 52-64.
50 Bamber L, Muston D, McLeod E. et al. Cost-effectiveness analysis of treatment of venous thromboembolism with rivaroxaban compared with combined low molecular weight heparin/vitamin K antagonist. Thromb J 2015; 13: 20

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