Cost of threating pulmonary thromboembolism

Aims: Primary aim of this study is to determine the financial burden of Vitamin K Antagonists (VKA), low molecular weight heparins (LMWH) and new oral anticoagulants (NOAC) which are used in the treatment of the pulmonary thromboembolism (PTE). Secondary aim is to show long term complications of the different treatment options such as bleeding, chronic thromboembolic pulmonary hypertension (CTEPH), recurrent pulmonary embolism etc. Materials and Methods: The patients who are diagnosed with PTE between May 2016 and March 2018 at Karadeniz Technical University Medical School Hospital were observed prospectively. Hospitalization costs were calculated on patients who were treated only for PTE by hospitalized in the Chest Diseases Service in the acute period. Maintenance costs were calculated over all patients who regulary admitted to our outpatient clinic with the diagnosis of PTE during study. The maintenance costs were calculated independently from the hospitalization costs. Diagnosis day of outpatients was accepted as the beginning of maintance period cost calculation. On the patients discharged, the day of discharge was accepted. The total follow-up period in the maintenance period was 6 months. Complications, costs of the complications and prevelance of CTEPH are determined. Data were presented as mean±SD and median±interquartilee range. A p-value of <0.05 was accepted to be significant. Results: A total of 148 patients were included in the study. Fifty five (37.2%) of the patients were male, 93 (62.8%) were female and the median age was 68 (range 18-95). The median hospitalization time and cost of patients who are discharged with warfarin treatment (n: 22) compared with patients discharged with LMWH (n: 22) was found to be increased (1316.82 TL 7,5 days / 803.36 TL, 5 days p<0,001). In the analysis of sixth month costs, LMWH cost was found to be significantly higher than VKA cost (6.927,15 ± 2.687,67 TL / 698.29 ± 483.51 TL p<0,001). However, although VKA treatment tended to be less expensive than treatment with NOAC, there was no statistical significance detected (698.29 ± 483.51 TL / 1.050,81 ± 300.28 TL p=0.140). There is no difference detected between the treatment options in the aspect of complication development. Conclusion: The use of LMWH increases the financial burden significantly compared to both NOAC and VKA treatments in the maintenance therapy of Pulmonary Thromboembolism. On the other hand, VKA treatment is tend to be cheaper than NOAC treatment. There is no difference between treatment agents in terms of complications and development of CTEPH.