Management of venous thromboembolism in cancer patients: the economic burden of hospitalizations
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Venous thromboembolism (VTE) is one of the most frequent events associated with cancer, requiring hospitalization and generating additional healthcare costs. To date, no studies analyzing the additional costs resulting from VTE associated with cancer in France have been published. The objective of this study was to provide an estimation of the additional cost induced by VTE with cancer by analyzing hospital stays reported in the 2013 PMSI French Hospital Database (“Programme de Médicalisation des Systèmes d’Information”, a national hospital administrative database) for four cancer types (breast, lung, hepatocellular carcinoma, and colon).
The analysis is divided into three parts: a descriptive evaluation of hospitalizations for VTE with cancer, an analysis by severity level of diagnosis-related groups (DRG), and an estimation of the hospital costs based on the National Reference Costs (ENC). The French public ATIH (“Agence Technique de l’Information sur l’Hospitalisation”, a national Agency for Data on Hospital Care) database was used. The critical approach of this study is based on analysis of the distribution of stays according to levels of severity of DRG.
A total of 14,251 hospitalizations were analyzed combining VTE and cancer. Hospitalizations of the two highest levels of severity (levels 3 and 4) for VTE with cancer represented 81.7 % of all hospitalizations in this population. Increased costs were seen for all four cancer types evaluated, with cost coefficients ranging from 1.34 to 2.01. For example, the average cost of lung cancer in cancer patients with VTE in the PMSI database was 7296 € versus 4647 € in the ATIH database. Cost coefficients were calculated, ranging from 1.34 in colon cancer, 1.50 for breast cancer, 1.57 in lung cancer, and 2.01 for hepatocellular carcinoma.
As discussed in the article, the current costs are high. Better physician adherence to clinical practice guidelines could potentially reduce these costs by lowering the number of recurrent VTE in patients with cancer.
KeywordsCancer Economic burden Hospitalization Venous thromboembolism
This work was supported by Pfizer PFE France, and remuneration was provided to authors.
Conflict of interest
The authors declare that they have no conflict of interest.
- 2.Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW, American College of Chest Physicians (2008) Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133(6 Suppl):381S–453SCrossRefPubMedGoogle Scholar
- 6.Thromboembolic Tisk Factors (THRIFT) Consensus Group (1992) Risk of and prophylaxis for venous thromboembolism in hospital patients. BMJ 305:567–574Google Scholar
- 8.Lee AYY, Levine MN, Baker RI, Bowden C, Kakkar AK, Prins M, Rickles FR, Julian JA, Haley S, Kovacs MJ, Gent M, Randomized Comparison of Low-Molecular-Weight Heparin versus Oral Anticoagulant Therapy for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer (CLOT) Investigators (2003) Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 349(no. 2):pp. 146–pp. 153CrossRefGoogle Scholar
- 10.Prandoni P, Lensing AWA, Piccioli A, Bernardi E, Simioni P, Girolami B, Marchiori A, Sabbion P, Prins MH, Noventa F, Girolami A (2002) Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 100(10):3484–3488CrossRefPubMedGoogle Scholar
- 13.ANSM, “Recommandations de bonne pratique : Prévention et traitement de la maladie thrombo-embolique veineuse en médecine.” [Online]. Available: http://ansm.sante.fr/var/ansm_site/storage/original/application/ae4209ebc36d7164d4b7c876ddeaabab.pdf
- 14.“Standards, Options & Recommandations : Traitement curatif de la maladie thromboembolique veineuse chez les patients atteints de cancer et prévention et traitement des thromboses veineuses sur cathéter chez les patients atteints de cancer.” [Online]. Available: http://www.parhtage.sante.fr/re7/bre/doc.nsf/VDoc/171C92CDDFA303E6C125753D004B6C65/$FILE/C28_MVTE%20Oncologie_FNCLCC_2008.pdf
- 15.Farge D, Debourdeau P, Beckers M, Baglin C, Bauersachs RM, Brenner B, Brilhante D, Falanga A, Gerotzafias GT, Haim N, Kakkar AK, Khorana AA, Lecumberri R, Mandala M, Marty M, Monreal M, Mousa SA, Noble S, Pabinger I, Prandoni P, Prins MH, Qari MH, Streiff MB, Syrigos K, Bounameaux H, Büller HR (2013) International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. J Thromb Haemost JTH 11(no. 1):pp. 56–pp. 70CrossRefGoogle Scholar
- 16.Lefebvre P, Laliberté F, Nutescu EA, Duh MS, LaMori J, Bookhart BK, Olson WH, Dea K, Schein J, Kaatz S (2012) All-cause and potentially disease-related health care costs associated with venous thromboembolism in commercial, Medicare, and Medicaid beneficiaries. J Manag Care Pharm JMCP 18(5):363–374PubMedGoogle Scholar
- 17.ATIH: rapport annuel 2014. Répartition des GHM par niveau de sévérité. http://www.atih.sante.fr/analyse-de-l-activite-hospitaliere-2014
- 21.Sevestre MA, Belizna C, Durant C, Bosson J-L, Vedrine L, Cajfinger F, Debourdeau P, Farge D, Carmen Investigators for the Groupe Francophone Thrombose et Cancer (GFTC) (2014) Compliance with recommendations of clinical practice in the management of venous thromboembolism in cancer: the CARMEN study. J Mal Vasc 39(3):161–168CrossRefPubMedGoogle Scholar
- 23.Pelzer U, Opitz B, Deutschinoff G, Stauch M, Reitzig PC, Hahnfeld S, Müller L, Grunewald M, Stieler JM, Sinn M, Denecke T, Bischoff S, Oettle H, Dörken B, Riess H (2015) Efficacy of Prophylactic Low–Molecular Weight Heparin for Ambulatory Patients With Advanced Pancreatic Cancer: Outcomes From the CONKO-004 Trial. J Clin Oncol p. JCO.2014.55.1481Google Scholar
- 25.Mahé I, Puget H, Buzzi JC, Lamuraglia M, Chidiac J, Strukov A, Helfer H, Perozziello A (2016) Adherence to treatment guidelines for cancer-associated thrombosis: a French hospital-based cohort study. Support Care Cancer. doi: 10.1007/s00520-016-3164-8