Estimated Annual Healthcare Costs After Acute Pulmonary Embolism: Results From a Prospective Multicentre Cohort Study

Katharina Mohr; Philipp Mildenberger; Thomas Neusius; Konstantinos C Christodoulou; Ioannis T Farmakis; Klaus Kaier; Stefano Barco; Frederikus A Klok; Lukas Hobohm; Karsten Keller; Dorothea Becker; Christina Abele; Leonhard Bruch; Ralf Ewert; Irene Schmidtmann; Philipp S Wild; Stephan Rosenkranz; Stavros V Konstantinides; Harald Binder; Luca Valerio

doi:10.1093/ehjqcco/qcae050

Estimated Annual Healthcare Costs After Acute Pulmonary Embolism: Results From a Prospective Multicentre Cohort Study

Eur Heart J Qual Care Clin Outcomes. 2024 Jul 1:qcae050. doi: 10.1093/ehjqcco/qcae050. Online ahead of print.

Authors

Katharina Mohr^{1

2}, Philipp Mildenberger³, Thomas Neusius⁴, Konstantinos C Christodoulou¹, Ioannis T Farmakis^{1

5}, Klaus Kaier², Stefano Barco^{1

6}, Frederikus A Klok^{1

7}, Lukas Hobohm^{1

5}, Karsten Keller^{1

5

8}, Dorothea Becker¹, Christina Abele^{1

9}, Leonhard Bruch¹⁰, Ralf Ewert¹¹, Irene Schmidtmann³, Philipp S Wild^{1

12

13}, Stephan Rosenkranz¹⁴, Stavros V Konstantinides^{1

15}, Harald Binder², Luca Valerio^{1

5}

Affiliations

¹ Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
² Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
³ Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
⁴ Wiesbaden Business School, RheinMain University of Applied Sciences, Wiesbaden, Germany.
⁵ Department of Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
⁶ Department of Angiology, University Hospital Zurich, Zurich, Switzerland.
⁷ Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
⁸ Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany.
⁹ School of Life Sciences, University of Siegen, Germany.
¹⁰ Klinik für Innere Medizin und Kardiologie, Unfallkrankenhaus Berlin, Berlin, Germany.
¹¹ Clinic for Internal Medicine, Greifswald University Hospital, Greifswald, Germany.
¹² Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
¹³ German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Germany.
¹⁴ Department of Cardiology, Heart Center at the University Hospital Cologne, and Cologne Cardiovascular Research Center, Cologne, Germany.
¹⁵ Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece.

PMID: 38950900
DOI: 10.1093/ehjqcco/qcae050

Abstract

Objective: Patients surviving acute pulmonary embolism (PE) necessitate long-term treatment and follow-up. However, the chronic economic impact of PE on European healthcare systems remains to be determined.

Methods and results: We calculated the direct cost of illness during the first year after discharge for the index PE, analyzing data from a multicentre prospective cohort study in Germany. Main and accompanying readmission diagnoses were used to calculate DRG-based hospital reimbursements; anticoagulation costs were estimated from the exact treatment duration and each drug's unique national identifier; and outpatient post-PE care costs from guidelines-recommended algorithms and national reimbursement catalogues. Of 1017 patients enrolled at 17 centres, 958 (94%) completed ≥ 3-month follow-up; of those, 24% were rehospitalized (0.34 [95% CI 0.30-0.39] readmissions per PE survivor). Age, coronary artery, pulmonary and kidney disease, diabetes, and (in the sensitivity analysis of 837 patients with complete 12-month follow-up) cancer, but not recurrent PE, were independent cost predictors by hurdle gamma regression accounting for zero readmissions. Estimated rehospitalization cost was €1138 (95% CI 896-1420) per patient. Anticoagulation duration was 329 (IQR 142-365) days, with estimated average per-patient costs of €1050 (median 972; IQR 458-1197); costs of scheduled ambulatory follow-up visits amounted to €181. Total estimated direct per-patient costs during the first year after PE ranged from €2369 (primary analysis) to €2542 (sensitivity analysis).

Conclusions: By estimating per-patient costs and identifying cost drivers of post-PE care, our study may inform decisions concerning implementation and reimbursement of follow-up programmes aiming at improved cardiovascular prevention. (Trial registration number: DRKS00005939).

Keywords: Anticoagulation; Cost of illness; Economic burden; Long-term care; Pulmonary embolism; Readmission.