Appropriate VTE Prophylaxis Is Associated with Lower Direct Medical Costs among Medical and Surgical Patients in the United States.
Authors: Amin Alpesh , Hussein Mohamed , Battleman David , Lin Jay , Stemkowski Steve , Merli Geno J 
Published: April 2020

Introduction: Patients hospitalized with cancer, chronic heart failure (CHF), orthopedic surgery, lung disease or severe infectious disease (SID) are at a high risk of developing venous thromboembolism (VTE). However, the appropriate use of prophylaxis can reduce the burden of VTE and lower VTE-associated costs. This retrospective cohort study investigated the adequacy of VTE prophylaxis received by US hospitalized at-risk patients and compares the total direct medical costs of appropriate and partial prophylaxis.

Methods: Patient discharges were selected from the Premier Perspective™ Database if they had a primary diagnosis of cancer, CHF, orthopedic surgery, lung disease, or SID, and were admitted between January and December 2003 (index hospitalization), were aged ≥40 years, and received some form of thromboprophylaxis based on American College of Chest Physicians (ACCP) guideline recommendations. Patients who died during the index hospitalization, transferred to another facility, received multiple classes of thromboprophylactic drugs, or received alternative prophylactic agents not recommended by the ACCP were excluded. Appropriate prophylaxis was defined as an ACCP-recommended prophylaxis option at the recommended dose and for the recommended duration. Partial prophylaxis was defined as receiving an ACCP-recommended prophylaxis option, but at an incorrect dose or for an insufficient duration. Total hospital costs were collected and mean costs are reported for discharges receiving appropriate and partial prophylaxis. Multivariate analysis (generalized linear model) was performed for hospitalization costs to control for differences in baseline and demographic covariates (including age, length of stay, and severity of illness) between groups

Results: A total of 703,084 discharges met the inclusion criteria, of whom 22.3% received appropriate prophylaxis and 77.7% received partial prophylaxis. The median length of hospital stay was 7 days in appropriate prophylaxis discharges and 8 days in partial prophylaxis discharges. Higher unadjusted total direct hospital costs were seen in discharges that received partial prophylaxis ($17,712) than in discharges receiving appropriate prophylaxis ($15,458). Following multivariate analysis to adjust for differences between groups, the total hospital costs remained $2,050 less in the appropriate prophylaxis group. Furthermore, appropriate prophylaxis was associated with a reduced cost in all medical conditions except for orthopedic surgery (Table 1).

Conclusions: VTE prophylaxis practices continue to be suboptimal; patients at risk of VTE and receiving a form of ACCP-recommended prophylaxis are nearly 3.5 times more likely to receive partial, inappropriate prophylaxis than fully appropriate prophylaxis. Furthermore, the total direct medical cost of patients receiving appropriate prophylaxis was lower than for those receiving partial prophylaxis. Appropriate prophylaxis makes sense not only from a efficacy or quality of care perspective, but also from an economic perspective based on the results of our study.

Table 1. Hospital costs associated with appropriate or partial prophylaxis (generalized linear model)

Diagnosis n n Mean total cost, $ (95% CI) Partial Appropriate Partial Cancer 16,342 73,654 11,384 (11,328–11,441) 12,582 (12,544–12,620) Orthopedic 6,817 9,272 15,214 (14,943–15,491) 14,618 (14,371–14,868) SID 93,743 323,710 12,836 (12,810–12,862) 14,765 (14,735–14,794) Lung Disease 22,033 82,702 14,045 (13,989–14,101) 15,367 (15,337–15,398) CHF 17,963 56,848 4,447 (4,420–4,656) 5,486 (5,459–5,514) All 156,898 546,186 14,765 (14,735–14,794) 16,815 (16,798–16,831)