Thromb Haemost 2022; 122(03): 427-433
DOI: 10.1055/a-1518-1847
Stroke, Systemic or Venous Thromboembolism

Home Treatment Compared to Initial Hospitalization in Normotensive Patients with Acute Pulmonary Embolism in the Netherlands: A Cost Analysis

1   Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
2   Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
,
Wilbert B. van den Hout
3   Department of Biomedical Data Science-Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
,
Thomas van Bemmel
4   Department of Internal Medicine, Gelre Hospital, Apeldoorn, The Netherlands
,
Ingrid M. Bistervels
5   Department of Internal Medicine, Flevoziekenhuis, Almere, The Netherlands
6   Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
,
Michiel Eijsvogel
7   Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
,
Laura M. Faber
8   Department of Internal Medicine, Rode Kruis Hospital, Beverwijk, The Netherlands
,
Herman M. A. Hofstee
9   Department of Internal Medicine, Haaglanden Medisch Centrum, The Hague, The Netherlands
,
Tom van der Hulle
1   Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
,
Antonio Iglesias del Sol
10   Department of Internal Medicine, Alrijne Hospital, Leiderdorp, The Netherlands
,
Marieke J. H. A. Kruip
11   Department of Haematology, Erasmus University Medical Center, Rotterdam, The Netherlands
,
Albert T. A. Mairuhu
2   Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
,
Saskia Middeldorp
6   Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
,
Mathilde Nijkeuter
12   Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
,
Menno V. Huisman
1   Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
,
Frederikus A. Klok
1   Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
,
for the YEARS Investigators › Author Affiliations

Abstract

Background Venous thromboembolism constitutes substantial health care costs amounting to approximately 60 million euros per year in the Netherlands. Compared with initial hospitalization, home treatment of pulmonary embolism (PE) is associated with a cost reduction. An accurate estimation of cost savings per patient treated at home is currently lacking.

Aim The aim of this study was to compare health care utilization and costs during the first 3 months after a PE diagnosis in patients who are treated at home versus those who are initially hospitalized.

Methods Patient-level data of the YEARS cohort study, including 383 normotensive patients diagnosed with PE, were used to estimate the proportion of patients treated at home, mean hospitalization duration in those who were hospitalized, and rates of PE-related readmissions and complications. To correct for baseline differences within the two groups, regression analyses was performed. The primary outcome was the average total health care costs during a 3-month follow-up period for patients initially treated at home or in hospital.

Results Mean hospitalization duration for the initial treatment was 0.69 days for those treated initially at home (n = 181) and 4.3 days for those initially treated in hospital (n = 202). Total average costs per hospitalized patient were €3,209 and €1,512 per patient treated at home. The adjusted mean difference was €1,483 (95% confidence interval: €1,181–1,784).

Conclusion Home treatment of hemodynamically stable patients with acute PE was associated with an estimated net cost reduction of €1,483 per patient. This difference underlines the advantage of triage-based home treatment of these patients.

Author Contributions

All authors have contributed significantly to this manuscript and take responsibility for the analyses.


Supplementary Material



Publication History

Received: 01 January 2021

Accepted: 22 May 2021

Publication Date:
26 May 2021 (online)

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany