Thromboembolism After Chemotherapy Raises Healthcare Costs About 30%

The development of venous thromboembolism (VTE) in patients with cancer has a significant impact in terms of morbidity and mortality and healthcare costs, according to a “real-world analysis” reported at the 2011 European Multidisciplinary Cancer Congress.

Gary H. Lyman, MD, MPH, an oncologist at Duke University School of Medicine, Durham, North Carolina, was principal investigator. Lyman is a frequent contributor in the area of health economics and comparative effectiveness research. “VTE development was associated with a significant economic burden in terms of healthcare expenditure,” he noted.

Lyman and colleagues assessed the economic impact of VTE occurrence using the US-based InVision Data Mart Multiplan/Integrated Health Care Information Solutions database. They retrospectively identified 30,552 patients with cancer who initiated chemotherapy in the 4-year period ending in 2008. Healthcare costs such as inpatient, pharmacy, emergency depart ment, and outpatient expenses were assessed 1 year preindex and postindex treatment (first day of chemotherapy after cancer diagnosis).

The incidence of VTE 3.5 months after the initiation of chemotherapy ranged from 4.8% to 11.9%, depending on tumor site. The highest risk was observed in patients with pancreatic, stomach, and lung cancers. The incidence continued to increase over time postindex treatment, peaking at 9.9% to 21.5% at 12 months, Lyman reported.

High Healthcare Costs
Patients who developed VTE within 3.5 months postindex treatment had healthcare costs at baseline that were comparable with persons not developing VTE. During the first year postindex, costs in patients with VTE were significantly higher than in those without VTE, primarily driven by higher inpatient and outpatient costs.

The overall healthcare costs 1 year before receiving chemotherapy were $37,542 for patients developing VTE and $35,342 for those without VTE. By 1 year postindex treatment, costs had risen to $110,362 and $77,984, respectively, Lyman reported.

Costs were higher for patients with VTE in each category of expenditure: inpatient, outpatient, emergency department, and pharmacy. “Similar results were seen for pa - tients who developed VTE within 12 months postindex,” he said.

“The decision for the use of thromboprophylaxis in cancer pa tients undergoing chemotherapy should be based on the balance between the potential benefits and harms, including any bleeding risk associated with a therapy,” Lyman pointed out. There is a need to assess cost-effectiveness of prevention in this setting, he added.