An Evaluation of the Impact of Recurrent Venous Thromboembolic Disease and Hemorrhagic Events within the Managed Care Setting.

Recurrent venous thromboembolic disease (VTE) has been associated with significant expenditures in health care charges. In this retrospective observational cohort study, managed care enrollees with an initial VTE and treated with warfarin were identified. The rate of recurrent VTE and hemorrhagic events, as well as health care charges incurred for these events were calculated. Study inclusion required a diagnosis of VTE between 01/01/98 through 12/31/00, age 18 or older, a pharmacy claim representing warfarin use 7 through 14 days after diagnosis, no VTE or anticoagulation use during the 6-month period prior to diagnosis and continuously enrolled in the health plan during the 6-month pre-index period through 360 through 720 days after diagnosis. A total of 1,973 patients were identified. Mean age was 69.4 ± 13.3 years and 57.3% were female. Overall, the median length of warfarin therapy was 4.7 months. During the follow-up period, 220 (11.2%) had an acute hospitalization for a subsequent event regardless of warfarin status. Of these, 139 patients (63.2%) experienced a recurrent VTE and 81 patients (36.8%) experienced a hemorrhagic event. Health care charges incurred for the first recurrent VTE or a hemorrhagic event were $15,575 ± $17,209 however, twenty patients experienced a second recurrent event (either VTE or hemorrhagic) and their health care charges increased to $37,356 ± $38,877.

Overall, 11.0% of patients with an initial VTE and who were treated with warfarin experienced a recurrent VTE or hemorrhagic event requiring hospitalization. These data highlight the importance of anticoagulation for secondary prevention of VTE and that multiple events (VTE or hemorrhagic) result in substantial health care expenditures.