The Economic Burden of Thromboembolic Events Among Patients with Immune-Mediated Diseases

Juliana Setyawan; Emma Billmyer; Fan Mu; Andres Yarur; Miriam L Zichlin; Hongbo Yang; Nathaniel Downes; Nassir Azimi; Vibeke Strand

doi:10.1007/s12325-021-02004-1

The Economic Burden of Thromboembolic Events Among Patients with Immune-Mediated Diseases

Adv Ther. 2022 Jan;39(1):767-778. doi: 10.1007/s12325-021-02004-1. Epub 2021 Dec 14.

Authors

Juliana Setyawan¹, Emma Billmyer², Fan Mu³, Andres Yarur⁴, Miriam L Zichlin², Hongbo Yang², Nathaniel Downes², Nassir Azimi⁵, Vibeke Strand⁶

Affiliations

¹ Arena Pharmaceuticals, Inc., San Diego, CA, USA.
² Analysis Group Inc., 111 Huntington Avenue, 14th Floor, Boston, MA, 02199, USA.
³ Analysis Group Inc., 111 Huntington Avenue, 14th Floor, Boston, MA, 02199, USA. Fan.Mu@analysisgroup.com.
⁴ Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA.
⁵ Sharp Grossmont Hospital, La Mesa, CA, USA.
⁶ Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA.

Abstract

Introduction: Thromboembolic events (TEs) are associated with considerable costs. However, there is a paucity of evidence quantifying the economic burden associated with TEs among patients with immune-mediated diseases (IMDs).

Methods: This retrospective cohort study used the IBM MarketScan^® Commercial and Medicare Supplemental Claims databases (2014-2018). Commercially insured adults with IMDs were classified into two cohorts based on diagnosis of TEs (deep vein thrombosis, pulmonary embolism, ischemic stroke, myocardial infarction). Patients in the TE cohort were matched on type of IMD, age, sex, and year of diagnosis to patients in the no TE cohort. In the TE cohort, the index date was the date of first TE following first IMD diagnosis. In the no TE cohort, the index date was assigned so the duration from first IMD diagnosis to index date matched the duration for the corresponding patient in the TE cohort. All-cause total healthcare costs were compared between cohorts in the 30-day and 1-year periods following the index date (inclusive). Unadjusted comparisons were conducted using Wilcoxon signed-rank tests. Adjusted results were estimated using generalized estimating equations with robust sandwich estimator.

Results: Overall, 9681 matched patients were included in each cohort (mean age 61.1 years; 63.7% female). The TE cohort had higher proportions of comorbidities than the no TE cohort (Charlson Comorbidity Index [1.5 vs. 0.9]; p < 0.0001). Adjusted all-cause total healthcare costs were significantly greater in the TE cohort versus no TE cohort in the 30-day and 1-year periods following the index date (cost difference: 30-day, $17,574; 1-year, $36,459; both p < 0.0001) and were driven by inpatient costs (cost difference: 30-day, $14,864; 1-year, $23,360; both p < 0.0001). TE-related healthcare costs were $15,955 and $20,239 in the 30-day and 1-year periods, respectively.

Conclusion: Among patients with IMDs, TEs are associated with substantial economic burden within 30-days and 1-year following the event.

Keywords: Cost; Deep vein thrombosis; Economic burden; Immune-mediated diseases; Ischemic stroke; Myocardial infarction; Pulmonary embolism; Thromboembolic events.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Female
Financial Stress*
Health Care Costs
Humans
Male
Medicare
Middle Aged
Retrospective Studies
Thromboembolism* / etiology
United States