Cost-effectiveness of managing low-risk pulmonary embolism patients without hospitalization. The low-risk pulmonary embolism prospective management study - 24/02/21
, Scott C. Woller, MD b, Scott M. Stevens, MD b, Valerie Aston, MBA c, Rich Patten, MD d, Todd Allen, MD a, Benjamin D. Horne, PhD, MPH e, Lydia Dong, MD, PhD f, James Lloyd, BS g, Greg Snow, PhD h, Troy Madsen, MD i, Patrick Fink, MD i, C. Gregory Elliott, MD jAbstract |
Objective |
Evaluate the cost-effectiveness and difference in length-of-stay when patients in the ED diagnosed with low-risk pulmonary embolism (PE) are managed with early discharge or observation.
Methods |
Single cohort prospective management study from January 2013 to October 2016 of patients with PE diagnosed in the ED and evaluated for a primary composite endpoint of mortality, recurrent venous thromboembolism, and/or major bleeding event at 90 days. Low-risk patients had a PE Severity Index score < 86, no evidence of proximal deep vein thrombosis on venous compression ultrasonography of both lower extremities, and no evidence of right heart strain on echocardiography. Patients were managed either in the ED or in the hospital on observation status. Primary outcomes were total length of stay, total encounter costs, and 30-day costs.
Results |
213 patients were enrolled. 13 were excluded per the study protocol. Of the remaining 200, 122 were managed with emergency department observation (EDO) and 78 with hospital observation (HO). One patient managed with EDO met the composite outcome due to a major bleeding event on day 61. The mean length of stay for EDO was 793.4 min (SD -169.7, 95% CI:762–823) and for HO was 1170 (SD -211.4, 95% CI:1122–1218) with a difference of 376.8 (95% CI: 430–323, p < 0.0001). Total encounter mean costs for EDO were $1982.95 and $2759.59 for HO, with a difference of $776.64 (95% CI: 972–480, p > 0.0001). 30-day total mean costs for EDO were $2864.14 and $3441.52 for HO, with a difference of $577.38 (95% CI: −1372-217, p = 0.15).
Conclusions |
Patients with low-risk PE managed with ED-based observation have a shorter length of stay and lower total encounter costs than patients managed with Hospital-based observation.
El texto completo de este artículo está disponible en PDF.Highlights |
• | Venous thromboembolism (VTE) is a common and sometimes morbid condition. |
• | Typical inpatient care of VTE with hospital observation is expensive, ~$8.7 K/visit. |
• | ED observation of low-risk PE has lower initial encounter costs than hospital observation. |
• | ED observation of low-risk PE has shorter length-of-stay than hospital observation. |
Keywords : Venous thromboembolism, Pulmonary embolism, PESI score, Health care costs, Health care expenditures, Emergency department observation
Abbreviations : Hospital Observation, ED Observation, Venous Thromboembolism, Pulmonary Embolism, Low-risk Pulmonary Embolism
Esquema
Vol 41
P. 80-83 - mars 2021 Regresar al número
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