Healthcare resource utilization and economic burden related to pulmonary embolism. An analysis of the PREFER in VTE study.

Survivors of acute pulmonary embolism carry a long-term risk of medical complications related to pulmonary embolism itself, pre-existing conditions or risk factors, and anticoagulation treatment, and their medical follow-up typically includes both planned and unplanned contacts and procedures. In addition, patients recovering from pulmonary embolism suffer from loss of physical performance, need for formal and informal support, and either permanent or temporary loss of work ability, all of which lead to significant personal and societal costs. Detailing this economic burden would support public health resource allocation and help to set priorities in devising and applying clinical prognostic tools to identify patients at high risk of requiring intensive treatment or considerable non-medical support in the long term. However, most data on costs and healthcare resource utilization focus on venous thromboembolism, which encompasses pulmonary embolism and deep vein thrombosis, rather than solely on pulmonary embolism, originate from Northern America and may not be readily applicable to Europe; and, in lack of prospectively collected data, are based on modelling strategies that heavily rely on assumptions rather than observed data.

The completion of large-scale phase IV and prospective registries studies such as the PREFER in venous thromboembolism (VTE) study provide for the first time large and thoroughly monitored real-world populations of patients treated for pulmonary embolism and, with them, the opportunity to thoroughly estimate resource utilization and overall costs during the long-term follow-up of patients with pulmonary embolism in Europe.

Over the past 15 years, no more than 20 studies have been conducted to study the economic burden related to some of the most frequent complications of venous thromboembolism or to venous thromboembolism itself, the vast majority of which have been included in a US and in a EU model for venous thromboembolism costs published by Dr. Mahan and by Dr. Barco in 2011-2012 and in 2014 (see Bibliography). These two studies were able to provide a comprehensive estimate of annualised venous thromboembolism cost for several Western countries: however, they necessarily based their estimates on (i) risks derived from the prior medical literature, (ii) costs and resource utilisations retrieved from national sources or, again, from the medical literature. The advantages of building a new model on the PREFER in venous thromboembolism data would be: (i) profiting from actual risks and utilisations retrieved and collected ad hoc, (ii) extrapolating these figures to the European countries where the study had been conducted.

Taking this into account, one may foresee that this information will be of interest for a population exceeding 200 million and, indirectly, for all stakeholders and investigators acting in the field of venous thromboembolism in Western countries. As a proxy, one should note that the two aforementioned manuscripts have been cited more than 200 times and been cited in international guidelines.