Prevalence of Venous Thromboembolism in Cancer Patients in the Emergency Department and Associated Healthcare Resource Utilization and Expenditure in the United States

Background Venous thromboembolism (VTE) is one of the leading causes of morbidity and mortality in cancer patients. We investigated VTE prevalence in cancer patients in the emergency department (ED) setting, associated utilization of health care resources and costs. Methods The Agency for Healthcare Research and Quality sponsored Nationwide Emergency Department Sample (NEDS) database was used to identify cancer patients and ED utilizations in 2006-12. The NEDS database captures 20% of US ED visits. Cancer types (solid tumor, lymphoma, leukemia, multiple myeloma) and acute venous thromboembolism [VTE, which includes deep vein thrombosis (DVT) and/or pulmonary embolism (PE)] were identified by ICD-9 codes. CPT procedure codes were used to identify any use of computed tomography pulmonary angiography (CTPA), CT chest with contrast (CTC), duplex ultrasound of the veins (DUS), or ventilation-perfusion (VQ) scan. Descriptive statistics were used to present the VTE prevalence, use of imaging study, admission rates and costs incurred. Chi-square test were used to compare death/admission rate and chi-square test for trend was used for trend analysis. Multivariable logistic regression modeling was used to explore the association between VTE diagnosis and hospital admission or death during hospital course after baseline characteristics adjustment. Results There were 6,330,322 ED visits by cancer patients in our study, which represented 3.2 % of total ED visits from 2006-2012 in the NEDS database. Over the study period, 1.6% of patients received either CTPA, CTC, DUS, or V/Q scan during their ED visits (CTPA: 0.56%; CTC: 0.47%; DUS: 0.62%; V/Q: 0.02%). The use of imaging studies had increased from 0.92 to 2.35 per 100 ED visits (Figure 1, p-value for trend Conclusions VTE diagnosed in the ED was associated with higher rate of mortality, hospital admissions, and healthcare-associated costs. Imaging studies for VTE are increasingly frequent, suggesting increased awareness by ED providers. Future clinical trials are warranted to investigate the cost-effectiveness of outpatient VTE prophylaxis among cancer patients in order to reduce VTE-associated burden. Disclosures Khorana: Halozyme: Consultancy, Honoraria; Janssen Scientific Affairs, LLC: Consultancy, Honoraria, Research Funding; Sanofi: Consultancy, Honoraria; Bayer: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria; Amgen: Consultancy, Research Funding; Leo: Consultancy, Honoraria, Research Funding.