Lin J, Lingohr-Smith M, Kwong W J
Novosys Health, 7 Crestmont Ct., Flemington, NJ 08822, USA.
J Manag Care Pharm. 2014 Feb;20(2):174-86. doi: 10.18553/jmcp.2014.20.2.174.
The third leading cause of cardiovascular-associated death, venous thromboembolism (VTE), represents a significant health care and economic burden. Although the burden of a one-time VTE event has been assessed, there are limited data regarding the burden of VTE recurrence.
To assess the rate and predictors of VTE recurrence within 1 year in the United States and evaluate the incremental health care resource utilization and costs associated with such VTE recurrences.
Patients (≥ 18 years) diagnosed with deep vein thrombosis and/or pulmonary embolism between January 1, 2008, and December 31, 2010, were identified from the Truven Health Analytics MarketScan Commercial and Medicare databases. The earliest VTE diagnosis was defined as the index VTE event. Patients were required to have 12 months of continuous insurance coverage before (baseline period) and after (follow-up period) the index event. Patients were further required to have initiated anticoagulant usage within 30 days of the index VTE event and have at least 30 days of treatment. The incidence of recurrent VTE, defined as a hospitalization or emergency room (ER) visit with a VTE diagnosis in the follow-up period, was determined for the commercially insured and Medicare populations separately. A proportional hazards model was used to assess the predictors of time to VTE recurrences. All cause and VTE-related health care resource utilization including hospitalizations, length of stay, outpatient medical service claims, and outpatient pharmacy claims were assessed along with the associated costs incurred during the 30-day and 12-month post-index event periods. Commercially insured and Medicare patients with and without recurrent VTE were evaluated and compared separately. Generalized linear models were used to further assess the incremental cost burden of recurrent VTE.
Among the commercially insured population, 29,275 patients were diagnosed with VTE and received anticoagulant therapy. A recurrence of VTE associated with a hospitalization or ER visit occurred within 12 months of the index VTE in 15.4% of patients with a mean time to recurrence of 74.1 days. Among the Medicare insured population (n = 14,509), 11.4% of patients experienced another VTE with a mean time to recurrence of 115.6 days. A consistent predictor of VTE recurrence across both populations was greater comorbidity as indicated by Charlson Comorbidity Index scores. Among commercially insured VTE patients, total payments for health care resource utilization for all causes, including inpatient, outpatient medical services, and outpatient pharmacy use were higher for patients with a recurrent VTE relative to those without a recurrent VTE ($82,110 [$106,918] vs. $36,918 [$54,852], P less than 0.001). The primary driver for the higher health care payments was greater use of inpatient care. Total payments for VTE-related resource use was also greater for patients with a VTE recurrence ($38,591 [$51,479] vs. $15,123 [$22,186], P less than 0.001) with the majority (62.9%) attributed to care that took place within 30 days of the index VTE. After adjustment for key patient characteristics, VTE recurrence was associated with 2.2-fold and 3.0-fold higher post-index health care payments for all causes and for VTE-related claims, respectively. Similar results were observed for the Medicare population.
VTE recurrence associated with a hospitalization or ER visit is associated with substantial health care resource utilization, which is primarily inpatient care undergone within the first 30 days following an initial VTE event. Thus, a sizeable portion of the economic burden of recurrent VTE is also incurred during this short period of time following an initial VTE event. Given that rates of VTE recurrence were high among patients identified as having received anticoagulant treatment, strategies to improve anticoagulation therapy among VTE patients in addition to other preventative measures are needed to lessen the health care and economic burdens of VTE.
静脉血栓栓塞症（VTE）是心血管相关死亡的第三大原因，给医疗保健和经济带来了重大负担。尽管已对一次性VTE事件的负担进行了评估，但关于VTE复发负担的数据有限。
评估美国1年内VTE复发的发生率和预测因素，并评估此类VTE复发相关的新增医疗保健资源利用情况和成本。
从Truven Health Analytics MarketScan商业和医疗保险数据库中识别出2008年1月1日至2010年12月31日期间诊断为深静脉血栓形成和/或肺栓塞的患者（≥18岁）。最早的VTE诊断被定义为索引VTE事件。患者在索引事件之前（基线期）和之后（随访期）需要有12个月的连续保险覆盖。患者还需要在索引VTE事件后30天内开始使用抗凝剂，并至少接受30天的治疗。分别确定商业保险人群和医疗保险人群中复发性VTE的发生率，复发性VTE定义为随访期内因VTE诊断而住院或急诊就诊。使用比例风险模型评估VTE复发时间的预测因素。评估包括住院、住院时间、门诊医疗服务索赔和门诊药房索赔在内的所有原因和与VTE相关的医疗保健资源利用情况，以及索引事件后30天和12个月期间产生的相关成本。对有和没有复发性VTE的商业保险和医疗保险患者分别进行评估和比较。使用广义线性模型进一步评估复发性VTE的增量成本负担。
在商业保险人群中，29275名患者被诊断为VTE并接受了抗凝治疗。15.4%的患者在索引VTE事件后的12个月内发生了与住院或急诊就诊相关的VTE复发，平均复发时间为74.1天。在医疗保险人群（n = 14509）中，11.4%的患者经历了另一次VTE，平均复发时间为115.6天。两个群体中VTE复发的一致预测因素是Charlson合并症指数评分所表明的更高合并症。在商业保险的VTE患者中，复发性VTE患者的所有原因的医疗保健资源利用总支付，包括住院、门诊医疗服务和门诊药房使用，相对于无复发性VTE的患者更高（82110美元[106918美元]对36918美元[54852美元]，P < 0.001）。更高医疗保健支付的主要驱动因素是住院治疗的更多使用。VTE复发患者的VTE相关资源使用总支付也更高（3859
