Nonmedical Burden of DVT Is High

Debra Wood, RN

February 2011, Vol 2, No 1 - Meeting Highlights

Orlando, FL—The economic burden associated with deep-vein thrombosis (DVT) during the 2-year period after diagnosis is substantial—$5094 Canadi an—with most of the costs occurring in the first 4 months, and postthrombotic syndrome representing a significant predictor of higher cost.

Raphael Guanella, MD“It is important to emphasize that the use of compression stockings could, maybe, decrease the cost of DVT by preventing postthrombotic syndrome,” said Raphael Guanella, MD, with the Division of Angiology and Hemostasis at the Geneva University Hospital, Switzerland, at the 52nd American Society of Hematology Annual Meeting and Exposition.

Dr Guanella and colleagues conducted a Canadian multicenter, costof- illness study of 355 consecutive patients diagnosed with objectively confirmed acute DVT at 1 of 7 participating hospitals in the province of Quebec from 2001 to 2004. Of the patients, 50% were male, and the median age was 57 years. Of the cohort, 70% were outpatients, 58% had a proximal DVT, and 15% had a pulmonary embolism.

The researchers followed patients for 2 years postdiagnosis and tracked medical and nonmedical costs related to DVT using patient-completed cost diaries filled out at baseline and 1, 4, 8, 12, and 24 months and at any DVTrelated clinical event; case report forms completed by nurses; and Quebec provincial administrative healthcare databases containing information on inpatient and outpatient cost.

Of the costs associated with DVT, 53% were nonmedical, including an average of 12 lost workdays, representing 58% of the cost; 38.6 hours of assistance needed, 33% of the cost; and 12.7 transportation trips. Hospitalizations accounted for 64% of the medical cost; provider visits, 17%; drugs, 15%; and other, 4%. Patients reported an average of 15 physician visits and 0.7 nonphysician visits.

“We were surprised to find more than half of the cost was nonmedical in nature,” Dr Guanella admitted.

Three variables were associated with higher costs: pulmonary embo lism at baseline; unprovoked DVT, occurring in 46% of patients; and postthrombotic syndrome during follow-up, which occurred in 40.8% of patients.

“Postthrom botic syndrome was a significant predictor of cost,” Dr Guanella add ed. “Postthrom botic syndrome patients had higher costs over time, especially later than 4 months after diagnosis.”

Patients with unprovoked DVT had a higher rate of hospitalization and medical visits. Higher costs in patients with postthrombotic syndrome were associated with more medical visits and the use of drugs