Drivers and recent trends of hospitalisation costs related to acute pulmonary embolism

doi:10.1007/s00392-024-02437-y

. 2024 Apr 2.

doi: 10.1007/s00392-024-02437-y. Online ahead of print.

Drivers and recent trends of hospitalisation costs related to acute pulmonary embolism

Katharina Mohr^#^{1

2}, Lukas Hobohm^#^{1

3}, Klaus Kaier², Ioannis T Farmakis^{1

3}, Luca Valerio¹, Stefano Barco^{1

4}, Christina Abele¹, Thomas Münzel^{3

5}, Thomas Neusius⁶, Stavros Konstantinides^{7

8}, Harald Binder^#², Karsten Keller^#^{1

3

9}

Affiliations

¹ Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
² Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
³ Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
⁴ Department of Angiology, University Hospital Zurich, Zurich, Switzerland.
⁵ German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany.
⁶ Wiesbaden Business School, RheinMain University of Applied Sciences, Wiesbaden, Germany.
⁷ Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany. stavros.konstantinides@unimedizin-mainz.de.
⁸ Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece. stavros.konstantinides@unimedizin-mainz.de.
⁹ Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany.

^# Contributed equally.

PMID: 38565711
DOI: 10.1007/s00392-024-02437-y

Drivers and recent trends of hospitalisation costs related to acute pulmonary embolism

Katharina Mohr et al. Clin Res Cardiol. 2024.

. 2024 Apr 2.

doi: 10.1007/s00392-024-02437-y. Online ahead of print.

Authors

Affiliations

¹ Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
² Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
³ Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
⁴ Department of Angiology, University Hospital Zurich, Zurich, Switzerland.
⁵ German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany.
⁶ Wiesbaden Business School, RheinMain University of Applied Sciences, Wiesbaden, Germany.
⁷ Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany. stavros.konstantinides@unimedizin-mainz.de.
⁸ Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece. stavros.konstantinides@unimedizin-mainz.de.
⁹ Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany.

^# Contributed equally.

PMID: 38565711
DOI: 10.1007/s00392-024-02437-y

Abstract

Background and aims: The socio-economic burden imposed by acute pulmonary embolism (PE) on European healthcare systems is largely unknown. We sought to determine temporal trends and identify cost drivers of hospitalisation for PE in Germany.

Methods and results: We analysed the totality of reimbursed hospitalisation costs in Germany (G-DRG system) in the years 2016-2020. Overall, 484 884 PE hospitalisations were coded in this period. Direct hospital costs amounted to a median of 3572 (IQR, 2804 to 5869) euros, resulting in average total reimbursements of 710 million euros annually. Age, PE severity, comorbidities and in-hospital (particularly bleeding) complications were identified by multivariable logistic regression as significant cost drivers. Use of catheter-directed therapy (CDT) constantly increased (annual change in the absolute proportion of hospitalisations with CDT + 0.40% [95% CI + 0.32% to + 0.47%]; P < 0.001), and it more than doubled in the group of patients with severe PE (28% of the entire population) over time. Although CDT use was overall associated with increased hospitalisation costs, this association was no longer present (adjusted OR 1.02 [0.80-1.31]) in patients with severe PE and shock; this was related, at least in part, to a reduction in the median length of hospital stay (for 14.0 to 8.0 days).

Conclusions: We identified current and emerging cost drivers of hospitalisation for PE, focusing on severe disease and intermediate/high risk of an adverse early outcome. The present study may inform reimbursement decisions by policymakers and help to guide future health economic analysis of advanced treatment options for patients with PE.

Keywords: Catheter-directed treatment; Cost of illness; Economic burden; Hospitalisation costs; Pulmonary embolism.

PubMed Disclaimer

Cited by

Time trends of catheter-directed treatment in acute pulmonary embolism in Germany.
Keller K, Schmidt FP, Farmakis IT, Barco S, Fengler K, Knorr M, Gori T, Münzel T, Lurz P, Hobohm L. Keller K, et al. Res Pract Thromb Haemost. 2024 Dec 9;9(1):102651. doi: 10.1016/j.rpth.2024.102651. eCollection 2025 Jan. Res Pract Thromb Haemost. 2024. PMID: 39834528 Free PMC article.
Enhanced recovery and abbreviated length of anticoagulation for thromboprophylaxis after primary hip arthroplasty rationale and design of the ENABLE-hip trial.
Drees P, Schmidtmann I, Herbst M, Becker D, Barco S, Klok FA, Keller K, Hobohm L, Christodoulou KC, Abele C, Bauersachs R, Ageno W, Grove EL, Kehlet H, Hufen F, Klonschinski T, Afghanyar Y, Eckhard L, Martin N, Fischer S, Gorbulev S, Rath D, Mavromanoli AC, Jabbour C, Lang I, Couturaud F, Heiss C, Binder H, Konstantinides S. Drees P, et al. J Thromb Thrombolysis. 2025 Aug;58(6):689-698. doi: 10.1007/s11239-025-03110-5. Epub 2025 May 29. J Thromb Thrombolysis. 2025. PMID: 40442449 Free PMC article.
Intensive care treatment in acute pulmonary embolism in Germany, 2016 to 2020: a nationwide inpatient database study.
Keller K, Sagoschen I, Farmakis IT, Mohr K, Valerio L, Wild J, Barco S, Schmidt FP, Gori T, Espinola-Klein C, Münzel T, Lurz P, Konstantinides S, Hobohm L. Keller K, et al. Res Pract Thromb Haemost. 2024 Aug 8;8(6):102545. doi: 10.1016/j.rpth.2024.102545. eCollection 2024 Aug. Res Pract Thromb Haemost. 2024. PMID: 39318771 Free PMC article.
Estimated annual healthcare costs after acute pulmonary embolism: results from a prospective multicentre cohort study.
Mohr K, Mildenberger P, Neusius T, Christodoulou KC, Farmakis IT, Kaier K, Barco S, Klok FA, Hobohm L, Keller K, Becker D, Abele C, Bruch L, Ewert R, Schmidtmann I, Wild PS, Rosenkranz S, Konstantinides SV, Binder H, Valerio L; FOCUS Investigators. Mohr K, et al. Eur Heart J Qual Care Clin Outcomes. 2025 May 1;11(3):334-342. doi: 10.1093/ehjqcco/qcae050. Eur Heart J Qual Care Clin Outcomes. 2025. PMID: 38950900 Free PMC article.

References

1. Wendelboe AM, Raskob GE (2016) Global burden of thrombosis: epidemiologic aspects. Circ Res 118:1340–1347. https://doi.org/10.1161/CIRCRESAHA.115.306841 - DOI - PubMed
1. Barco S, Mahmoudpour SH, Valerio L, Klok FA, Munzel T, Middeldorp S, Ageno W, Cohen AT, Hunt BJ, Konstantinides SV (2020) Trends in mortality related to pulmonary embolism in the European Region, 2000–15: analysis of vital registration data from the WHO Mortality Database. Lancet Respir Med 8:277–287. https://doi.org/10.1016/S2213-2600(19)30354-6 - DOI - PubMed
1. Martin KA, Molsberry R, Cuttica MJ, Desai KR, Schimmel DR, Khan SS (2020) Time trends in pulmonary embolism mortality rates in the United States, 1999 to 2018. J Am Heart Assoc 9:e016784. https://doi.org/10.1161/JAHA.120.016784 - DOI - PubMed - PMC
1. Barco S, Valerio L, Ageno W, Cohen AT, Goldhaber SZ, Hunt BJ, Iorio A, Jimenez D, Klok FA, Kucher N, Mahmoudpour SH, Middeldorp S, Munzel T, Tagalakis V, Wendelboe AM, Konstantinides SV (2021) Age-sex specific pulmonary embolism-related mortality in the USA and Canada, 2000–18: an analysis of the WHO Mortality Database and of the CDC Multiple Cause of Death database. Lancet Respir Med 9:33–42. https://doi.org/10.1016/S2213-2600(20)30417-3 - DOI - PubMed
1. Giri J, Sista AK, Weinberg I, Kearon C, Kumbhani DJ, Desai ND, Piazza G, Gladwin MT, Chatterjee S, Kobayashi T, Kabrhel C, Barnes GD (2019) Interventional therapies for acute pulmonary embolism: current status and principles for the development of novel evidence: a scientific statement from the American Heart Association. Circulation 140:e774–e801. https://doi.org/10.1161/CIR.0000000000000707 - DOI - PubMed

LinkOut - more resources

Full Text Sources
- Springer

[1] Wendelboe AM, Raskob GE (2016) Global burden of thrombosis: epidemiologic aspects. Circ Res 118:1340–1347. https://doi.org/10.1161/CIRCRESAHA.115.306841 - DOI - PubMed

[2] Wendelboe AM, Raskob GE (2016) Global burden of thrombosis: epidemiologic aspects. Circ Res 118:1340–1347. https://doi.org/10.1161/CIRCRESAHA.115.306841 - DOI - PubMed

[3] Barco S, Mahmoudpour SH, Valerio L, Klok FA, Munzel T, Middeldorp S, Ageno W, Cohen AT, Hunt BJ, Konstantinides SV (2020) Trends in mortality related to pulmonary embolism in the European Region, 2000–15: analysis of vital registration data from the WHO Mortality Database. Lancet Respir Med 8:277–287. https://doi.org/10.1016/S2213-2600(19)30354-6 - DOI - PubMed

[4] Barco S, Mahmoudpour SH, Valerio L, Klok FA, Munzel T, Middeldorp S, Ageno W, Cohen AT, Hunt BJ, Konstantinides SV (2020) Trends in mortality related to pulmonary embolism in the European Region, 2000–15: analysis of vital registration data from the WHO Mortality Database. Lancet Respir Med 8:277–287. https://doi.org/10.1016/S2213-2600(19)30354-6 - DOI - PubMed

[5] Martin KA, Molsberry R, Cuttica MJ, Desai KR, Schimmel DR, Khan SS (2020) Time trends in pulmonary embolism mortality rates in the United States, 1999 to 2018. J Am Heart Assoc 9:e016784. https://doi.org/10.1161/JAHA.120.016784 - DOI - PubMed - PMC

[6] Martin KA, Molsberry R, Cuttica MJ, Desai KR, Schimmel DR, Khan SS (2020) Time trends in pulmonary embolism mortality rates in the United States, 1999 to 2018. J Am Heart Assoc 9:e016784. https://doi.org/10.1161/JAHA.120.016784 - DOI - PubMed - PMC

[7] Barco S, Valerio L, Ageno W, Cohen AT, Goldhaber SZ, Hunt BJ, Iorio A, Jimenez D, Klok FA, Kucher N, Mahmoudpour SH, Middeldorp S, Munzel T, Tagalakis V, Wendelboe AM, Konstantinides SV (2021) Age-sex specific pulmonary embolism-related mortality in the USA and Canada, 2000–18: an analysis of the WHO Mortality Database and of the CDC Multiple Cause of Death database. Lancet Respir Med 9:33–42. https://doi.org/10.1016/S2213-2600(20)30417-3 - DOI - PubMed

[8] Barco S, Valerio L, Ageno W, Cohen AT, Goldhaber SZ, Hunt BJ, Iorio A, Jimenez D, Klok FA, Kucher N, Mahmoudpour SH, Middeldorp S, Munzel T, Tagalakis V, Wendelboe AM, Konstantinides SV (2021) Age-sex specific pulmonary embolism-related mortality in the USA and Canada, 2000–18: an analysis of the WHO Mortality Database and of the CDC Multiple Cause of Death database. Lancet Respir Med 9:33–42. https://doi.org/10.1016/S2213-2600(20)30417-3 - DOI - PubMed

[9] Giri J, Sista AK, Weinberg I, Kearon C, Kumbhani DJ, Desai ND, Piazza G, Gladwin MT, Chatterjee S, Kobayashi T, Kabrhel C, Barnes GD (2019) Interventional therapies for acute pulmonary embolism: current status and principles for the development of novel evidence: a scientific statement from the American Heart Association. Circulation 140:e774–e801. https://doi.org/10.1161/CIR.0000000000000707 - DOI - PubMed

[10] Giri J, Sista AK, Weinberg I, Kearon C, Kumbhani DJ, Desai ND, Piazza G, Gladwin MT, Chatterjee S, Kobayashi T, Kabrhel C, Barnes GD (2019) Interventional therapies for acute pulmonary embolism: current status and principles for the development of novel evidence: a scientific statement from the American Heart Association. Circulation 140:e774–e801. https://doi.org/10.1161/CIR.0000000000000707 - DOI - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Drivers and recent trends of hospitalisation costs related to acute pulmonary embolism

Affiliations

Drivers and recent trends of hospitalisation costs related to acute pulmonary embolism

Authors

Affiliations

Abstract

Similar articles

Cited by

References

LinkOut - more resources

Full Text Sources

Abstract

Similar articles

Cited by

References

Related information

LinkOut - more resources

Full Text Sources