Abstract: Poster Presentations |


Alpesh Amin, MD*; Jay Lin, PhD; Barbara H. Johnson; Kathy L. Schulman
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University of California - Irvine, Anaheim, CA


Chest. 2009;136(4_MeetingAbstracts):142S. doi:10.1378/chest.136.4_MeetingAbstracts.142S-a
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PURPOSE:  Venous thromboembolism (VTE) is associated with a substantial economic burden that can be reduced using VTE prophylaxis in at-risk patient populations. Prophylaxis is frequently prescribed inappropriately, but the economic implications of this are not known. This study compared the cost of appropriate prophylaxis (in adherence with the Seventh American College of Chest Physicians [ACCP] guidelines) with partial prophylaxis (that which does not completely conform to ACCP guidelines) in patients at risk of VTE receiving enoxaparin, the most frequently used low-molecular-weight heparin, or unfractionated heparin (UFH).

METHODS:  The MarketScan® Hospital Drug Database from Thomson Reuters (January 2004–March 2007), was used to retrieve information on medical and surgical patients at risk of VTE, who were aged ≥ 40 years, had a US hospital stay ≥ 6 days and who received either enoxaparin or UFH. Univariate and multivariate (adjusting for patient and hospital characteristics) analyses were used to compare total hospital charges (billing), hospital-based costs, and length of hospital stay between discharges for patients who received appropriate or partial prophylaxis.

RESULTS:  Of the 21,001 discharge records included, appropriate prophylaxis was received by only 5,136 (24.5%) patients. The total hospital charges, hospital costs and length of hospital stay were significantly lower for appropriate prophylaxis compared with partial prophylaxis (Table). For total hospital cost per discharge, the unadjusted mean difference in favor of appropriate prophylaxis was $6,437 (95% confidence intervals [CI] $5,865–7,010; p < 0.001). Following adjustment for hospital and patient characteristics, appropriate prophylaxis remained $6,370 less costly than partial prophylaxis (95% CI $6,067–6,670; p < 0.0001). The proportion of cost-saving that was related to VTE rate reduction was not studied in this analysis.

CONCLUSION:  In patients at risk of VTE receiving enoxaparin or UFH, appropriate prophylaxis was associated with lower total hospital costs than partial prophylaxis.

CLINICAL IMPLICATIONS:  The economic burden of VTE may be reduced by improving adherence with guideline recommendations.

DISCLOSURE:  Alpesh Amin, Grant monies (from industry related sources) Alpesh Amin has received research honorarium from sanofi-aventis U.S. Inc. Kathy Schulman/Barbara Johnson are employees of Thomson Reuters, which has received research grants from sanofi-aventis, US Inc.; Employee Jay Lin is an employee of sanofi-aventis US, Inc.; Consultant fee, speaker bureau, advisory committee, etc. Alpesh Amin is on the speakers bureau for sanofi-aventis U.S. Inc; Other The authors received editorial/writing support in the preparation of this abstract funded by sanofi-aventis U.S., Inc. The authors were fully responsible for all content and editorial decisions and received no financial support or other form of compensation related to the development of the manuscript; No Product/Research Disclosure Information

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