Direct medical costs of venous thromboembolism and subsequent hospital readmission rates: an administrative claims analysis from 30 managed care organizations.

BACKGROUND: Venous thromboembolism (VTE) is a common medical condition manifested as deep vein thrombosis (DVT) or pulmonary embolism (PE). Few data exist on the total economic burden of DVT and PE.

OBJECTIVE: To (1) quantify the economic burden of DVT and PE in direct medical costs and utilization and (2) determine the rates of hospital readmission for DVT and PE.

METHODS: Hospital claims containing DVT or PE as a primary or secondary discharge diagnosis during the period February 1998 through June 2004 were identified by retrospective analysis using the Integrated Health Care Information Services (IHCIS) National Managed Care Database. For the cost analysis, we included patients that had been enrolled in a health care plan for a minimum of 30 days prior to and 365 days following the DVT or PE hospitalization. For the readmission analysis, patients were required to have a minimum length of stay of 3 days and a pre-enrollment of 365 days. We quantified the cost burden to the health plan by examining annual DVT- and PE-related payments made by the health plan to providers for inpatient and outpatient care.

RESULTS: Of 5 million plus discharges in the database with dates of service between February 1, 1998, and June 30, 2004, 32,193 (0.64%) had DVT or PE as a primary discharge diagnosis, and 26,159 (0.52%) had DVT or PE as a secondary discharge diagnosis. After application of the inclusion and exclusion criteria, there were 5,348 patients with a primary discharge diagnosis of DVT and 4,593 patients with a secondary discharge diagnosis of DVT. For PE, 2,984 patients had a primary discharge diagnosis, and 1,119 had a secondary discharge diagnosis. The hospital readmission rates within 1 year for the combined diagnoses (DVT or PE) were 5.3% for primary and 14.3% for secondary diagnoses; 44.3% of the PE readmissions occurred within the first 30 days. Within 90 days, 50.7% of DVT readmissions and 58.6% of PE readmissions occurred. Regarding cost for a primary diagnosis, the average total annual provider payments made by a health plan were $10,804 for DVT and $16,644 for PE. For secondary diagnoses, the average total annual costs were $7,594 for DVT and $13,018 for PE. The mean hospital cost per readmission for a recurrent DVT ($11,862) was higher than the mean cost for the initial hospitalization ($9,805, P=0.006), but the mean cost per PE readmission ($14,722) was similar to the mean cost for the initial hospitalization ($14,146, P =0.38).

CONCLUSIONS: The economic burden of DVT and PE in direct medical cost is large, due not only to the initial hospitalization event, but also to the high rate of hospital readmission (5%-14%), over half of which occurs within 90 days.