Cost-of-Illness Analysis of Long-Term Health Care Resource Use and Disease Burden in Patients With Pulmonary Embolism: Insights From the PREFER in VTE Registry

Abstract

Background As mortality from pulmonary embolism (PE) decreases, the personal and societal costs among survivors are receiving increasing attention. Detailing this burden would support an efficient public health resource allocation. We aimed to provide estimates for the economic and disease burden of PE also accounting for long-term health care use and both direct and indirect costs beyond the acute phase. Methods and Results This is a cost-of-illness analysis with a bottom-up approach based on data from the PREFER in VTE registry (Prevention of Thromboembolic Events-European Registry in Venous Thromboembolism). We calculated direct (clinical events and anticoagulation) and indirect costs (loss of productivity) of an acute PE event and its 12-month follow-up in 2020 Euros. We estimated a disability weight for the 12-month post-PE status and corresponding disability adjusted life years presumably owing to PE. Disease-specific costs in the first year of follow-up after an incident PE case ranged between 9135 Euros and 10 620 Euros. The proportion of indirect costs was 42% to 49% of total costs. Costs were lowest in patients with ongoing cancer, mainly because productivity loss was less evident in this already burdened population. The calculated disability weight for survivors who were cancer free 12 months post-PE was 0.017, and the estimated disability adjusted life years per incident case were 1.17. Conclusions The economic burden imposed by PE to society and affected patients is considerable, and productivity loss is its main driver. The disease burden from PE is remarkable and translates to the loss of roughly 1.2 years of healthy life per incident PE case.

Keywords: burden of disease; cost‐of‐illness; disability weight; disability‐adjusted life years; productivity loss; pulmonary embolism.

Figure 1. Average total costs (low and high average) per patient profile (overall, cancer, provoked no cancer, unprovoked) in the PREFER in VTE (Prevention of Thromboembolic Events—European Registry in Venous Thromboembolism) registry (absolute costs in 2020 Euros [€]).

Figure 2. Proportion of each cost input category to the total average costs per incident pulmonary embolism patient in the PREFER in VTE (Prevention of Thromboembolic Events—European Registry in Venous Thromboembolism) registry. PE indicates pulmonary embolism.

Figure 3. Contribution of each category of anticoagulant in the costs attributed to anticoagulation during follow‐up of patients in the PREFER in VTE (Prevention of Thromboembolic Events—European Registry in Venous Thromboembolism) registry (absolute costs in 2020 Euros).

DOAC indicates direct oral anticoagulant; LMWH, low‐molecular‐weight heparin; and VKA, vitamin K antagonist.