The Impacts of Thromboembolic Events in Breast and Prostate Cancer Patients: Incidence, Hospitalization Duration and Costs
Authors: Borget Isabelle , Meyer Guy , Vainchtock Alexandre , Martelli Nicolas , Scotté Florian , Elalamy Ismail 
Published: October 2019

Abstract
Background: Cancer patients represent an at-risk population for Venous Thromboembolic Events (VTE). We intended to determine the incidence and recurrence rate of VTE in breast cancer (BC) and prostate cancer (PC) French patients, to evaluate their impacts on the number and the duration of hospitalizations and to calculate their additional cost for hospitals.
Methods: The French national hospital database (PMSI) was used to identify BC and PC patients diagnosed in 2010 who were hospitalized for a VTE during the following two years. The number of stays induced by a VTE, the number of patients hospitalized or re-hospitalized and the time before recurrent event were determined using the disease-specific ICD-10 codes, among all VTEs classified as primary or related diagnosis (PD / RD) and significant associated diagnosis (SAD). Subsequently, we evaluated the extra cost and extra length of stay when a VTE ocurred during a hospitalization: respectively 275 stays for breast cancer and 292 stays for prostate cancer during which a VTE occurred and prolonged the stay (cancer was classified as PD/PR and the VTE as SAD) were matched and compared to similar stays without VTE. We calculated the hospital costs using the French official tariffs, from the perspective of the third-party payer.
Results: We identified 62,365 new patients with BC and 45,551 new patients with PC. During the two-year follow-up period, 1,271 with BC (2.0%) and 997 with PC (2.2%) were hospitalized for a VTE or experienced a VTE during a hospital stay. In total, 1,604 and 1,210 stays related to first VTE or recurrent VTE were analyzed for BC patients and PC patients, respectively. We found that 202 BC patients and 144 PC patients were re-hospitalized at least once for a recurrent VTE, representing 546 admissions (19.4% of total admissions). In those patients with VTE recurrence, median time before recurrent event was 23 days in BC patients and 25 days in PC patients.
The comparison between stays during which a VTE occurred and stays without VTE showed that the duration of hospital stay was longer in patients with VTE: in public hospitals, median stay duration for BC patients with VTE raised by 133% to 7 days (vs. 3 days for BC patients without VTE), and by 67% to 10 days for PC patients (vs. 6 days for patients without VTE). VTE consequently induced a significant extra cost related to hospitalizations over the two years of follow-up: the median expenditure per stay showed an increase of 37.3% in BC, up to 5,518 Euros (vs. 4,018 Euros per stay without VTE) and of 21.7% in PC up to 6,200 Euros (vs. 5,094 Euros per stay without VTE).
Conclusion: VTE appeared to make cancer management much heavier as patients faced increased hospital stays number and duration whereas healthcare system faced important additional costs. This burden may be reduced by decreasing the occurrence of thromboembolic complications and their recurrence in cancer patients, with better prevention and follow-up measures.

Table. Hospital stay duration in patients with breast or prostate cancer as PD / RD and VTE as significant associated diagnosis compared to patients without VTE (in public hospitals) Median stay duration (days) Mean stay duration (days) Breast cancer Patients with VTE 7 11.32 Patients without VTE 3 4.56 Prostate cancer Patients with VTE 10 13.52 Patients without VTE 6 6.98

Disclosures
Borget: LEO Pharma: Honoraria. Meyer:LEO Pharma: Research Funding. Vainchtock:HEVA: Research Funding. Martelli:LEO Pharma: Honoraria. Scotté:LEO Pharma: Honoraria.