Health care costs associated with venous thromboembolism in selected high-risk ambulatory patients with solid tumors undergoing chemotherapy in the United States

Alok A Khorana,¹ Mehul R Dalal,² Jay Lin,³ Gregory C Connolly<sup>1

1</sup>Division of Oncology/Hematology, James P Wilmot Cancer Center, University of Rochester, Rochester, NY, ²sanofi-aventis US, Bridgewater, NJ, 3Novosys Health, Flemington, NJ, USA

Background: This study examines venous thromboembolism (VTE)-associated resource utilization and real-world costs in ambulatory patients initiating chemotherapy for selected common high-risk solid tumors.
Methods: Health care claims data (2004–2009) from the IMS/PharMetrics^® Patient-Centric database were collected for propensity score-matched adult cancer (lung, colorectal, pancreatic, gastric, bladder, or ovarian) patients initiating chemotherapy with VTE (n = 912) and without VTE (n = 2736). Health care resource utilization (inpatient, outpatient, and outpatient prescription drug claims) and costs were compared between the two cohorts during the 12-month follow-up period after the index VTE event. Incremental costs were adjusted for demographic and clinical covariates.
Results: Cancer patients with VTE had approximately three times as many all-cause hospitalizations (mean 1.38 versus 0.55 per patient) and days in hospital (10.19 versus 3.37), and more outpatient claims (331 versus 206) than cancer patients without VTE (all P < 0.0001). Cancer patients with VTE incurred higher overall all-cause inpatient costs (mean USD 21,299 versus USD 7459 per patient), outpatient costs (USD 53,660 versus USD 34,232 per patient), and total health care costs (USD 74,959 versus USD 41,691 per patient) than cancer patients without VTE (all P < 0.0001). Total mean VTE-related health care costs were USD 9247 per patient over 12 months. Adjusted mean incremental all-cause health care costs of VTE were USD 30,538 per patient for cancer overall, ranging from USD 11,946 for gastric to USD 38,983 for pancreatic cancer.
Conclusion: VTE is associated with significant inpatient and outpatient resource utilization, and increased all-cause (in addition to VTE-related) health care costs among ambulatory cancer patients. Measures to prevent outpatient cancer-associated VTE may reduce health care utilization and costs in this population.
Keywords: cancer, venous thromboembolism, resource utilization, health care costs, cohort study