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High Economic Burden Associated with Thromboembolism in Patients with Cancer

October 2012, Vol 3, No 7

Vienna, Austria—A review of 34,000 patients with cancer in an insurance claims database showed that during the first 12 months after the diagnosis of cancer, the overall cost of developing venous thromboembolism (VTE) was approximately $100,000 per patient, reported Duke University researchers at the 2012 European Society for Medical Oncology.

“VTE development is associated with a significant economic burden in terms of healthcare expenditures,” said Nicole M. Kuderer, MD, a medical instructor of hematology/oncology at Duke University School of Medicine, Durham, NC.

Dr Kuderer and colleagues calculated the economic impact of VTE on 34,144 patients with breast or prostate cancer based on claims in the US IMPACT database. The index date was defined as the first day of chemotherapy after being diagnosed with cancer.

Patients with at least 12 months of continuous medical coverage before the index date and at least 3.5 months of coverage during follow-up were included. Patients with a previous VTE event within 12 months before the index date were excluded from the analysis.

Patients who developed VTE had more comorbid conditions and more metastatic disease compared with those who did not develop VTE, but they were otherwise similar at baseline. The incidence of VTE was assessed at 3.5 months and 12 months after the index date, and costs were evaluated 12 months after the initiation of chemotherapy.

High Rates of VTE

The rates of VTE after 3.5 months of chemotherapy initiation were 3.6% in patients with prostate cancer and 3.9% in patients with breast cancer; after 12 months, these rates were 8.1% and 7.1%, respectively.

“The cumulative rate of VTE in pros­tate and breast cancer patients almost doubled at 12 months,” Dr Kuderer said.  For both cancer types, more than 70% of VTE events were deep-vein throm­boses, and more than 60% occurred in the outpatient setting.

Healthcare Costs

A comparison of patients who did and did not develop VTE by 12 months after receiving chemotherapy showed that the cost of VTE was $7744 in the average patient with breast cancer and $8498 in the average patient with prostate cancer. However, the adjusted annual costs for the average patient with cancer and VTE rose to $90,690 compared with $56,142 for patients with cancer who did not have VTE (P <.001) during the 12 months after initiating chemotherapy, Dr Kuderer reported.

At the end of the 12-month period, the costs were higher for patients with breast cancer ($109,825) than for those with prostate cancer ($80,584).

Before being diagnosed with either type of cancer, the baseline costs for the patients with VTE were approximately $5000 greater than for those who did not subsequently develop VTE.

The analysis did not consider the cost-effectiveness of thrombopro­phylaxis in these patients, but such studies are needed. “The decision to use thromboprophylaxis in cancer patients undergoing chemotherapy should be based on the balance between the potential benefit and harm, including any bleeding risk,” Dr Kuderer suggested.

Cost-effectiveness and cost-utility studies of VTE prevention in patients with cancer are needed, especially in the outpatient cancer setting, Dr Kuderer added.

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