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Are There Any Differences in the Clinical and Economic Outcomes Between US Cancer Patients Receiving Appropriate or Inappropriate Venous Thromboembolism Prophylaxis?

School of Medicine, University of California-Irvine, Irvine, CA; sanofi-aventis, Bridgewater, NJ; and Premier Inc, Charlotte, NC

Corresponding author: Alpesh N. Amin, MD, MBA, University of California-Irvine, 101 The City Drive South, Building 58, Room 110, ZC-4076H, Orange, CA 92868; anamin{at}uci.edu.

Purpose: Despite evidence-based recommendations existing for the prevention of venous thromboembolism (VTE) in cancer patients, prophylaxis is often underused and inappropriately prescribed. This study compared the efficacy and cost of appropriate and partial prophylaxis in cancer patients at risk of VTE.

Methods: Discharge records for inpatients age 40 years, with a primary cancer diagnosis, and receiving some form of American College of Chest Physicians (ACCP) –recommended therapy in the Premier Perspective database (Premier Inc, Charlotte, NC; January 2002 to December 2006) were categorized into appropriate (in accordance with ACCP recommendations) or partial prophylaxis (inappropriate type, insufficient dose, or insufficient duration of prophylaxis) groups. VTE events, death, 30-day readmission, major and minor bleeds, and hospital costs were compared between groups using univariate and multivariate regression analysis.

Results: Of the 83,794 discharges included, only 16% received appropriate prophylaxis. Partial prophylaxis conferred a significantly increased risk in hospital-acquired VTE (odds ratio [OR], 3.09; 95% CI, 2.51 to 3.80; P < .001), in-hospital death (OR, 1.48; 95% CI, 1.29 to 1.69; P < .001), and 30-day VTE readmission (OR, 3.11; 95% CI, 1.54 to 6.26; P = .002) compared with appropriate prophylaxis. No major bleeds were recorded in the database and no difference was observed in the rates of minor bleeding. The total cost per discharge was higher for partial prophylaxis ($17,128) than appropriate prophylaxis ($15,384), with an adjusted mean difference of $1,275 in favor of appropriate prophylaxis.

Conclusion: In cancer patients at risk of VTE, appropriate prophylaxis reduced the hospital costs and incidence of VTE, mortality, and VTE readmission compared with partial prophylaxis. Increased appropriate use of ACCP recommendations may reduce the clinical and economic burden of VTE.

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Preventing Venous Thromboembolism in Cancer Patients: Can We Do Better?

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