Hospital Readmissions for Venous Thromboembolism a Substantial Cost in Patients with Cancer

Real-world data highlight the significant clinical and economic burden associated with venous thromboembolism (VTE) in patients with cancer. The data come from a study of 12,785 patients hospitalized with acute illnesses, of which 2002 patients had cancer. The results were presented at ASH 2018 and showed that 3.9% of patients with cancer experienced a VTE event requiring rehospitalization—the highest proportion of patients among the study population. Moreover, 28.2% of VTE-related readmissions occurred within the first 30 days of initial hospital discharge.

In addition to the clinical risk associated with VTEs, these adverse events are very costly, with mean total costs of approximately $35,000 per rehospitalization.

“We must continue to work on risk-assessing patients appropriately for VTE prior to discharge and handling the continuum of care for VTE prevention,” said Alpesh J. Amin, MD, MBA, Professor, Medicine; Chair, Department of Medicine; and Executive Director, Hospitalist Program, University of California Irvine School of Medicine.

“Studies have shown that in certain populations, like gastric and gynecological cancer patients, VTE prophylaxis for 14 days across the continuum might be useful, but these data suggest that it might be useful in nonsurgical and medical oncology populations, as well,” Dr Amin said.

Study Parameters

According to Dr Amin, cancer, and a history of cancer, are important risk factors for VTE-related hospitalization, yet VTE prophylaxis in these patients is challenging and underutilized. Several studies have shown that as many as 70% of patients with cancer are not receiving VTE prophylaxis, Dr Amin said, which puts this population at an increased risk for ­recurrent VTE (manifesting as deep-vein thrombosis and/or pulmonary embolism) and rehospitalizations.

Dr Amin and colleagues retrospectively analyzed data for patients hospitalized for acute illnesses (including cancer heart failure, infectious diseases, ischemic stroke, respiratory diseases, and rheumatic diseases), using hospital discharge diagnosis codes between 2011 and 2015 from the Truven Health MarketScan database, a large healthcare research database. Patients aged ≥40 years with continuous insurance coverage in the 6 months before initial hospitalization and in the 6 months after hospital discharge were included in the study.

Of the 12,785 enrolled patients, 15.7% (N = 2002) were hospitalized for cancer. The length of stay in patients with cancer was approximately the same as that for the overall population; however, the frequency of readmission was highest for patients with cancer among all medical illnesses investigated in this study.

Among patients hospitalized for cancer, 3.9% had a VTE-related readmission in the 6 months after discharge; 51.3% of these were VTE as a primary diagnosis. Overall, 28.2% of the VTE-­related hospital readmissions occurred within the first 30 days after discharge.

High Cost of VTE

The mean length of hospital stay was 7.6 days, and the mean total cost for a hospital readmission was $35,012 for VTE-related readmissions. For primary VTE readmissions, the mean length of stay was 5.2 days and the mean total cost of a readmission was $19,961. Although a significant cost, Dr Amin noted that the economic burden of VTE-related admissions in patients with cancer was less than in the overall population.

“On average, patients with cancer spent 2 fewer days in the hospital than the overall population for VTE-related readmissions, which led to slightly lower costs,” said Dr Amin. “This might be because patients with cancer have better continuity infrastructure across the board to get patients moving quicker.”

He cited potential study limitations, which are typical for claims studies, including potential coding errors, and potential geographic limitations of the Truven Health MarketScan database. Nevertheless, the database is generally considered robust in data, said Dr Amin, who emphasized that these results underscore the need for better VTE prophylaxis.

“Improvement in VTE prophylaxis for patients with cancer may reduce the risk and frequency of VTE, and thus hospital readmissions, reducing the clinical and economic burden of VTE in this patient population,” Dr Amin concluded.

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