Abstract 251: The Economic Implications Of Avoidable Therapeutic Obstacles In The Treatment Of Venous Thromboembolism
Objective: Venous thromboembolism - deep vein thrombosis (DVT) and pulmonary embolism (PE) - affects an estimated 900,000 individuals, and is responsible for as many as 100,000 deaths each year in the US. Patients with a history of DVT/PE have heightened risk of recurrence. Initial parenteral anticoagulation (low molecular weight heparin [LMWH]) is standard treatment for acute DVT/PE followed by ≥3 months of warfarin, which itself introduces the risk of major bleeding. Balancing the increased risks of major bleeding and recurrent DVT/PE remains a challenge. Recent clinical trials show that rivaroxaban, an oral direct inhibitor of factor Xa, is as effective as standard therapy for acute DVT/PE and, when continued into the outpatient setting, may provide an effective, safe, single-drug, and simplified approach to treatment. We consider the economic implications of these data in the context of a commercial health plan.
Methods: We used a decision-analytic model to estimate the annual economic burden of DVT/PE to a hypothetical commercial plan. Hospital days, acute and 1 year cost were assessed. The baseline scenario assumes that all patients with DVT/PE receive standard treatment (LMWH/warfarin). A projected scenario assumes that 75% of patients receive standard treatment, and 25% are treated with rivaroxaban. Rates of major bleed, non-major bleed, and recurrent DVT/PE events in the year following the acute DVT/PE are drawn from clinical trials. DVT/PE prevalence and healthcare costs are estimated based on published literature.
Results: In a hypothetical plan of 1 million, our baseline model projects that management of acute DVT/PE (standard treatment) would consume 12,786 inpatient days (69% associated with DVT; 31% with PE) and $59.6 million (2013 USD). Treatment for 74 recurrent DVT/PE events (84% DVT) would cost $1.4 million; major bleed events (39; 64% DVT) and non-major bleed events (207; 70% DVT) would require an additional $1 million to treat.
In the projected scenario, a 25% shift to oral anticoagulation with rivaroxaban reduced the number of inpatient days for acute management of DVT/PE to 11,753 (67% DVT), a reduction of 1,033 days (8%). Associated acute care costs totaled $57.7 million (73% DVT), a reduction of $1.9 million (3%). Overall, recurrent DVT/PE events and costs decreased by 6% (4 events; $82,000). In the projected scenario, 4 (10%) major bleeding events were prevented, at the cost of 1 (0.5%) additional non-major bleeding event which, taken together, reduced net healthcare utilization to manage bleeding events by about $91,000.
Conclusion: Our model suggests that the reduction in inpatient utilization, recurrent DVT/PE events, and major bleed events resulting from a shift of 25% from standard therapy to oral anticoagulation with rivaroxaban following an acute DVT/PE event would generate about $2 million in savings for every 1 million patients enrolled in a commercial health plan.
Author Disclosures: A.A. Patel: A. Employment; Significant; Janssen Scientific Affairs, LLC. K. Ogden: G. Consultant/Advisory Board; Modest; Janssen Scientific Affairs, LLC. S.H. Mody: A. Employment; Significant; Janssen Scientific Affairs, LLC. B. Bookhart: A. Employment; Significant; Janssen Scientific Affairs, LLC.
- © 2014 by American Heart Association, Inc.