The economic burden of incident venous thromboembolism in the United States: A review of estimated attributable healthcare costs

Highlights

• An incident case of VTE results in preventable medical costs of about $20,000.

• VTE is estimated to cost the US healthcare system at least $7–12 billion per year.

• Additional research is needed to assess preventable costs for specific groups.

Abstract

Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is an important cause of preventable mortality and morbidity. In this study, we summarize estimates of per-patient and aggregate medical costs or expenditures attributable to incident VTE in the United States. Per-patient estimates of incremental costs can be calculated as the difference in costs between patients with and without an event after controlling for differences in underlying health status. We identified estimates of the incremental per-patient costs of acute VTEs and VTE-related complications, including recurrent VTE, post-thrombotic syndrome, chronic thromboembolic pulmonary hypertension, and anticoagulation-related adverse drug events. Based on the studies identified, treatment of an acute VTE on average appears to be associated with incremental direct medical costs of $12,000 to $15,000 (2014 US dollars) among first-year survivors, controlling for risk factors. Subsequent complications are conservatively estimated to increase cumulative costs to $18,000–23,000 per incident case. Annual incident VTE events conservatively cost the US healthcare system $7–10 billion each year for 375,000 to 425,000 newly diagnosed, medically treated incident VTE cases. Future studies should track long-term costs for cohorts of people with incident VTE, control for comorbid conditions that have been shown to be associated with VTE, and estimate incremental medical costs for people with VTE who do not survive. The costs associated with treating VTE can be used to assess the potential economic benefit and cost-savings from prevention efforts, although costs will vary among different patient groups.

Introduction

Estimates of costs of disease can be used to project the benefit of prevention [1], [2]. Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is associated with more than one-half million hospitalizations in the United States (US) each year [3], and is a contributing cause in 100,000 or more deaths [4], [5]. It causes long-term morbidity, notably post-thrombotic syndrome (PTS) following DVT and chronic thromboembolic pulmonary hypertension (CTEPH) following PE. Medical costs for VTE in the US have been estimated to total $5–10 billion per year [6]. Published estimates of the total economic impact of VTE, including the value of lost economic output due to premature mortality, are as high as $69 billion per year [7], [8]. This paper reviews published estimates of the burden of VTE on the US healthcare system in terms of per-patient and aggregate incremental direct medical costs.

Estimates of the incidence of clinically validated VTE diagnoses fall in the range of 1.0–1.5 per 1000 persons per year, excluding studies of adults over 45 years. Two US studies reported all-age annual incidence of 1.18 per 1000 population in Rochester County, MN, during 1991–1997 [9] and 1.33 per 1000 population in Worcester, MA, during 2009 [10]. Applied to the US population of approximately 320 million people those incidence rates suggest 375,000–425,000 recognized incident VTE cases per year, not including cases that remain undiagnosed and untreated. Two population-based studies from Canada and France reported incident (first) VTE diagnoses in 1.22–1.36 per 1000 people [11], [12]. Two prospective Norwegian cohort studies of adults of all ages reported incidence rates of 1.43–1.48 per 1000 person-years [13], [14], which applied to 245 million US adults implies 350,000–365,000 incident cases per year in adults. Because VTE is a chronic condition, prevalence exceeds incidence; 1 million Americans may have prevalent treated VTE [15].