Economics of DVT Treatment
The costs of DVT and PTS to patients, hospital systems and society are high, with the greatest costs incurred due to DVT progressing to PTS.
Deep venous thrombosis (DVT) occurs in 5 to 20% of total hip replacement cases in those patients who are prophylactically anticoagulated. For those patients who are not anticoagulated, the rate may rise to 50%. This study modeled the economic effects of DVT and its long term complications in patients receiving a total hip replacement.
The natural history of DVT for use in the model was obtained from review of the literature. Inpatient costs were estimated from the average DRG payment for the procedure plus physician fees for follow-up care. Outpatient care was based on Medicare reimbursement rates for physician and laboratory fees. Home healthcare costs were estimated from the DMEPOS Fee Schedule. Analyses were based on a 72 year old patient with maximum survival to age 100.
Net life-term expectancy for the DVT patients was 3.34 years less than controls. The annual cost of mild to moderate post-thrombotic syndrome (PTS) was $839 the first year and $349 in subsequent years. Severe PTS cost for the first year was $3817 and $1677 in subsequent years. Patient cost for an episode of DVT was $3798 and $6604 for pulmonary embolism (PE). Lifetime discounted cost of DVT complications was estimated to be $3069.
Reference: Caprini, JA, MF Botterman, et al. Economic Burden of Long-Term Complications of Deep Vein Thrombosis after Total Hip Replacement Surgery in the United States. Value in Health 2003; 6:59-74.
Key Learnings:
- Total hip replacement patients who develop DVT may live significantly shorter lives than those who do not develop DVT
- The cost of treatment of DVT and PE is very high
- The cost of PTS in the first year is high, with continuing costs over the long-term
- The severity of PTS is predictive of the cost of care