Estimated annual healthcare costs after acute pulmonary embolism: results from a prospective multicentre cohort study
Authors: Mohr Katharina , Mildenberger Philipp , Neusius Thomas , Christodoulou Konstantinos C , Farmakis Ioannis T , Kaier Klaus , Barco Stefano , Klok Frederikus A , Hobohm Lukas , Keller Karsten , Becker Dorothea , Abele Christina , Bruch Leonhard , Ewert Ralf , Schmidtmann Irene , Wild Philipp S , Rosenkranz Stephan , Konstantinides Stavros V , Binder Harald , Valerio Luca ,   The FOCUS Investigators, Barco Stefano , Becker Dorothea , Fischer Brunhilde , Hobohm Lukas , Käberich Anja , Keller Karsten , Klok Frederikus A , Konstantinides Stavros V , Martin Nadine , Mavromanoli Anna C , Otto Silke , Schmidt Kai-Helge , Valerio Luca , Wild Philipp S , Bruch Leonhard , Geistert Stefanie , Schüler Katrin , Ewert Ralf , Pohl Claudia , Pieper Jeannette , Faehling Martin , Blaich Birgit , Landmesser Annika , Rosenkranz Stephan , Gerhardt Felix , Rudolph Jasmin , Gün Sibel , Ghofrani Hossein-Ardeschir , George Ute , Grünig Ekkehard , Egenlauf Benjamin , Salkić Amina , Heier Eva-Maria , Halank Michael , Tausche Kristin , Rink Tina , Jäkel Diana , Held Matthias , Schröder Barbara , Hoeper Marius M , Freise Julia , Tayler Susanne , Leuchte Hanno H , Horn Annika , Meyer F Joachim , Emge-Rossa Dagmar , Thabaret Karine , Neurohr Claus , Barton Juergen , Opitz Christian , Bressem Ines , Seyfarth Hans-Jürgen , Berger Patricia , Hennig Angela , Wachter Rolf , Hellenkamp Kristian , Sentler Carmen , Schulte Martina , Wilkens Heinrike , Trudzinski Franziska , Holtz Ines , Mayer Eckhard , Fistera David , Grgic Aleksandar 
Published: June 2024

Abstract

Aims
Patients surviving acute pulmonary embolism (PE) necessitate long-term treatment and follow-up. We estimated, the chronic economic impact of PE on the German healthcare system.

Methods and results
We calculated the direct cost of illness during the first year after discharge for the index PE, analysing data from a multicentre prospective cohort study in Germany. Main and accompanying readmission diagnoses were used to calculate DRG-based hospital reimbursements; anticoagulation costs were estimated from the exact treatment duration and each drug's unique national identifier; and outpatient post-PE care costs from guidelines-recommended algorithms and national reimbursement catalogues. Of 1017 patients enrolled at 17 centres, 958 (94%) completed ≥3-month follow-up; of those, 24% were rehospitalized (0.34 [95% CI 0.30–0.39] readmissions per PE survivor). Age, coronary artery, pulmonary and kidney disease, diabetes, and (in the sensitivity analysis of 837 patients with complete 12-month follow-up) cancer, but not recurrent PE, were independent cost predictors by hurdle gamma regression accounting for zero readmissions. The estimated rehospitalization cost was €1138 (95% CI 896–1420) per patient. Anticoagulation duration was 329 (IQR 142–365) days, with estimated average per-patient costs of €1050 (median 972; IQR 458–1197); costs of scheduled ambulatory follow-up visits amounted to €181. Total estimated direct per-patient costs during the first year after PE ranged from €2369 (primary analysis) to €2542 (sensitivity analysis).

Conclusion
By estimating per-patient costs and identifying cost drivers of post-PE care, our study may inform decisions concerning implementation and reimbursement of follow-up programmes aiming at improved cardiovascular prevention.