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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

Stephan V. Hendriks 
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 › Institutsangaben
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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.

Keywords

costs - home treatment - hospitalization - pulmonary embolism

Author Contributions

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


Supplementary Material



Publikationsverlauf

Eingereicht: 01. Januar 2021

Angenommen: 22. Mai 2021

Accepted Manuscript online:
26. Mai 2021

Artikel online veröffentlicht:
06. Juli 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Raskob GE, Angchaisuksiri P, Blanco AN. et al; ISTH Steering Committee for World Thrombosis Day. Thrombosis: a major contributor to global disease burden. Arterioscler Thromb Vasc Biol 2014; 34 (11) 2363-2371
    CrossrefPubMedGoogle Scholar
  • 2 Barco S, Mahmoudpour SH, Valerio L. et al. Trends in mortality related to pulmonary embolism in the European Region, 2000–15: analysis of vital registration data from the WHO Mortality Database. Lancet Respir Med 2019; DOI: 10.1016/S2213-2600(19)30354-6.
    CrossrefPubMedGoogle Scholar
  • 3 Barco S, Valerio L, Ageno W. et al. Age-sex specific pulmonary embolism-related mortality in the USA and Canada, 2000–18: an analysis of the WHO Mortality Database and of the CDC Multiple Cause of Death database. Lancet Respir Med 2020; DOI: 10.1016/S2213-2600(20)30417-3.
    CrossrefPubMedGoogle Scholar
  • 4 Zorginstituut Nederland. Screeningsrapport Systematische analyse Bloed- en immuunziekten Zinnige Zorg. Accessed June 8, 2021 at: https://www.zorginstituutnederland.nl/publicaties/rapport/2019/04/23/zinnige-zorg---rapport-screeningsfase-bloed--en-immuunziekten
    PubMedGoogle Scholar
  • 5 Stein PD, Matta F, Hughes PG. et al. Home treatment of pulmonary embolism in the era of novel oral anticoagulants. Am J Med 2016; 129 (09) 974-977
    CrossrefPubMedGoogle Scholar
  • 6 van der Wall SJ, Hendriks SV, Huisman MV, Klok FA. Home treatment of acute pulmonary embolism: state of the art in 2018. Curr Opin Pulm Med 2018; 24 (05) 425-431
    CrossrefPubMedGoogle Scholar
  • 7 Koopman MM, Prandoni P, Piovella F. et al; The Tasman Study Group. Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home. N Engl J Med 1996; 334 (11) 682-687
    CrossrefPubMedGoogle Scholar
  • 8 Levine M, Gent M, Hirsh J. et al. A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis. N Engl J Med 1996; 334 (11) 677-681
    CrossrefPubMedGoogle Scholar
  • 9 Agterof MJ, Schutgens RE, Snijder RJ. et al. Out of hospital treatment of acute pulmonary embolism in patients with a low NT-proBNP level. J Thromb Haemost 2010; 8 (06) 1235-1241
    CrossrefPubMedGoogle Scholar
  • 10 Otero R, Uresandi F, Jiménez D. et al. Home treatment in pulmonary embolism. Thromb Res 2010; 126 (01) e1-e5
    CrossrefPubMedGoogle Scholar
  • 11 Zondag W, Mos IC, Creemers-Schild D. et al; Hestia Study Investigators. Outpatient treatment in patients with acute pulmonary embolism: the Hestia Study. J Thromb Haemost 2011; 9 (08) 1500-1507
    CrossrefPubMedGoogle Scholar
  • 12 den Exter PL, Zondag W, Klok FA. et al; Vesta Study Investigators *. Efficacy and safety of outpatient treatment based on the hestia clinical decision rule with or without N-terminal pro-brain natriuretic peptide testing in patients with acute pulmonary embolism. a randomized clinical trial. Am J Respir Crit Care Med 2016; 194 (08) 998-1006
    CrossrefPubMedGoogle Scholar
  • 13 Aujesky D, Roy PM, Verschuren F. et al. Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomised, non-inferiority trial. Lancet 2011; 378 (9785): 41-48
    CrossrefPubMedGoogle Scholar
  • 14 van der Wall SJ, Hendriks SV, Huisman MV, Klok FA. Home treatment of acute pulmonary embolism: state of the art in 2018. Curr Opin Pulm Med 2018; 24 (05) 425-431
    CrossrefPubMedGoogle Scholar
  • 15 Huisman MV, Barco S, Cannegieter SC. et al. Pulmonary embolism. Nat Rev Dis Primers 2018; 4: 18028
    CrossrefPubMedGoogle Scholar
  • 16 Zondag W, Kooiman J, Klok FA, Dekkers OM, Huisman MV. Outpatient versus inpatient treatment in patients with pulmonary embolism: a meta-analysis. Eur Respir J 2013; 42 (01) 134-144
    CrossrefPubMedGoogle Scholar
  • 17 van der Hulle T, Kooiman J, den Exter PL, Dekkers OM, Klok FA, Huisman MV. Effectiveness and safety of novel oral anticoagulants as compared with vitamin K antagonists in the treatment of acute symptomatic venous thromboembolism: a systematic review and meta-analysis. J Thromb Haemost 2014; 12 (03) 320-328
    CrossrefPubMedGoogle Scholar
  • 18 Klok FA, Huisman MV. When I treat a patient with acute pulmonary embolism at home. Hematology (Am Soc Hematol Educ Program) 2020; 2020 (01) 190-194
    CrossrefPubMedGoogle Scholar
  • 19 Weeda ER, Wells PS, Peacock WF. et al. Hospital length-of-stay and costs among pulmonary embolism patients treated with rivaroxaban versus parenteral bridging to warfarin. Intern Emerg Med 2017; 12 (03) 311-318
    CrossrefPubMedGoogle Scholar
  • 20 Badreldin H. Hospital length of stay in patients initiated on direct oral anticoagulants versus warfarin for venous thromboembolism: a real-world single-center study. J Thromb Thrombolysis 2018; 46 (01) 16-21
    CrossrefPubMedGoogle Scholar
  • 21 Basto AN, Fewel NP, Vo K, Stock EM, Ta M. Initiation of direct oral anticoagulants versus warfarin for venous thromboembolism: impact on time to hospital discharge. J Thromb Thrombolysis 2018; 45 (01) 51-55
    CrossrefPubMedGoogle Scholar
  • 22 van der Hulle T, Cheung WY, Kooij S. et al; YEARS study group. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. Lancet 2017; 390 (10091): 289-297
    Google Scholar
  • 23 Huisman MV, Klok FA. How I diagnose acute pulmonary embolism. Blood 2013; 121 (22) 4443-4448
    CrossrefPubMedGoogle Scholar
  • 24 Zorginstituut Nederland. 2019 . Accessed June 8, 2021 at: https://www.medicijnkosten.nl/
    PubMedGoogle Scholar
  • 25 (FNT) FDTS. Samenvatting Medische Jaarverslagen. 2018 . Accessed December 2019 at: https://www.fnt.nl/algemeen/jaarverslagen
    PubMedGoogle Scholar
  • 26 Zorginstituut Nederland. Evaluatie van de ervaringen en kosten van antistollingszorg. Available at: https://www.zorginstituutnederland.nl/publicaties/rapport/2020/10/20/evaluatie-antistollingszorg
    PubMedGoogle Scholar
  • 27 Hakkaart-van Roijen L, Van der Linden N, Bouwmans CAM, Kanters TA, Tan SS. Costing manual: Methodology of costing research and reference prices for economic evaluations in healthcare [in Dutch: Kostenhandleiding: Methodologie van kostenonderzoek en referentieprijzen voor economische evaluaties in de gezondheidszorg]. Available at: https://www.zorginstituutnederland.nl/binaries/zinl/documenten/publicatie/2016/02/29/richtlijn-voor-het-uitvoeren-van-economische-evaluaties-in-de-gezondheidszorg/Richtlijn+voor+het+uitvoeren+van+economische+evaluaties+in+de+gezondheidszorg+%28verdiepingsmodules%29.pdf
    PubMedGoogle Scholar
  • 28 Kanters TA, Bouwmans CAM, van der Linden N, Tan SS, Hakkaart-van Roijen L. Update of the Dutch manual for costing studies in health care. PLoS One 2017; 12 (11) e0187477
    CrossrefPubMedGoogle Scholar
  • 29 van der Pol LM, Dronkers CEA, van der Hulle T. et al. The YEARS algorithm for suspected pulmonary embolism: shorter visit time and reduced costs at the emergency department. J Thromb Haemost 2018; 16 (04) 725-733
    CrossrefPubMedGoogle Scholar
  • 30 Hendriks SV, Bavalia R, van Bemmel T. et al; YEARS investigators. Current practice patterns of outpatient management of acute pulmonary embolism: a post-hoc analysis of the YEARS study. Thromb Res 2020; 193: 60-65
    CrossrefPubMedGoogle Scholar
  • 31 Amin A, Deitelzweig S, Bucior I. et al. Frequency of hospital readmissions for venous thromboembolism and associated hospital costs and length of stay among acute medically ill patients in the US. J Med Econ 2019; 22 (11) 1119-1125
    CrossrefPubMedGoogle Scholar
  • 32 Dalen JE, Dalen Jr JE. Unnecessary hospitalizations for pulmonary embolism: impact on US health care costs. Am J Med 2016; 129 (09) 899-900
    CrossrefPubMedGoogle Scholar
  • 33 Vanni S, Becattini C, Nazerian P. et al. Early discharge of patients with pulmonary embolism in daily clinical practice: a prospective observational study comparing clinical gestalt and clinical rules. Thromb Res 2018; 167: 37-43
    CrossrefPubMedGoogle Scholar
  • 34 Fernandez MM, Hogue S, Preblick R, Kwong WJ. Review of the cost of venous thromboembolism. Clinicoecon Outcomes Res 2015; 7: 451-462
    CrossrefPubMedGoogle Scholar