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Observational Study
. 2015 Mar 27;10(3):e0121429.
doi: 10.1371/journal.pone.0121429. eCollection 2015.

Impact of thromboprophylaxis across the US acute care setting

Wei Huang  1 , Frederick A Anderson  1 , Sophie K Rushton-Smith  1 , Alexander T Cohen  2
Affiliations
Observational Study

Impact of thromboprophylaxis across the US acute care setting

Wei Huang et al. PLoS One. .

Abstract

Background: The risk of venous thromboembolism (VTE) can be reduced by appropriate use of anticoagulant prophylaxis. VTE prophylaxis does, however, remain substantially underused, particularly among acutely ill medical inpatients. We sought to evaluate the clinical and economic impact of increasing use of American College of Chest Physicians (ACCP)-recommended VTE prophylaxis among medical inpatients from a US healthcare system perspective.

Methods and findings: In this retrospective database cost-effectiveness evaluation, a decision-tree model was developed to estimate deaths within 30 days of admission and outcomes attributable to VTE that might have been averted by use of low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH). Incremental cost-effectiveness ratio was calculated using "no prophylaxis" as the comparator. Data from the ENDORSE US medical inpatients and the US nationwide Inpatient Sample (NIS) were used to estimate the annual number of eligible inpatients who failed to receive ACCP-recommended VTE prophylaxis. The cost-effectiveness analysis indicated that VTE-prevention strategies would reduce deaths by 0.5% and 0.3%, comparing LMWH and UFH strategies with no prophylaxis, translating into savings of $50,637 and $25,714, respectively, per death averted. The ENDORSE findings indicated that 51.1% of US medical inpatients were at ACCP-defined VTE risk, 47.5% of whom received ACCP-recommended prophylaxis. By extrapolating these findings to the NIS and applying cost-effectives analysis results, the full implementation of ACCP guidelines would reduce number of deaths (by 15,875 if using LMWH or 10,201 if using UFH), and was extrapolated to calculate the cost reduction of $803M for LMWH and $262M for UFH.

Conclusions: Efforts to improve VTE prophylaxis use in acutely ill inpatients are warranted due to the potential for reducing VTE-attributable deaths, with net cost savings to healthcare systems.

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Conflict of interest statement

Competing Interests: Wei Huang: sanofi. Frederick A. Anderson Jr.: has received research grants from sanofi-aventis and The Medicines Company. He has served as a consultant to GSK and Millennium on the design of outcomes studies. Sophie K. Rushton-Smith: consultancy for Bayer, Sanofi, Boehringer-Ingelheim and Bristol-Myers Squibb. Alexander T. Cohen: Dr. A. T. Cohen is a medical consultant, and has received consultancy and clinical trial funding from many pharmaceutical companies, including Bayer, Boehringer-Ingelheim, BMS, Daiichi, GSK, Johnson and Johnson, Mitsubishi Pharma, Pfizer, Portola, sanofi-aventis, Schering Plough, and Takeda. He is an advisor to the UK Government Health Select Committee, the all-party working group on thrombosis, the Department of Health, and the NHS, on the prevention of VTE. He is also an advisor to Lifeblood: the thrombosis charity and is the founder of the European educational charity the Coalition to Prevent Venous Thromboembolism. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Application of findings from the ENDORSE US population [11, 15] to patients in the 2006 NIS population [13].
aCalculated.
Fig 2
Fig 2. One-way sensitivity analyses to determine the threshold value of (A) the probability of PE after DVT without treatment; and (B) probability of death among PE patients who survived the period immediately after the acute event without treatment, among 10,000 acutely ill medical inpatients at ACCP-defined VTE risk.
ACCP, American College of Chest Physicians; bid, twice daily; DVT, deep vein thrombosis; IU, international units; PE, pulmonary embolism; qd, daily; VTE, venous thromboembolism.
Fig 3
Fig 3. Cost-effectiveness acceptability curve based on a Monte Carlo simulation (10,000 iterations).
bid, twice daily; IU, international units; qd, daily; VTE, venous thromboembolism.
See this image and copyright information in PMC

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Grants and funding

The study was designed and conducted by the investigators and funded via a research grant from sanofi-aventis to the Center for Outcomes Research, University of Massachusetts Medical School. The sponsor had no role in study design, data analysis, decision to publish, or writing of the manuscript. This manuscript was written by the authors, who take full responsibility for its content. The specific roles of each author is outlined in the author contributions section.