Background:
Current available factor replacement therapy (FRT) for von Willebrand Disease (vWD) contains FVIII. Thromboembolic events (TEE) are a small but serious risk in patients with elevated FVIII levels as a result of accumulation from repeated doses of FRT (Manucci, 2004).
Aim:
To assess the total medical cost incurred in one year of treating TEEs in vWD.
Methods:
This retrospective database analysis utilized the Marketscan®Database, a US medical claims database, from Jan 2006 to Mar 2014. Patients with inpatient diagnosis for a TEE (ICD-9 code for venous thromboembolism [VTE], myocardial infarction [MI], ischemic stroke [IS], etc.) were identified, with the first inpatient TEE visit defined as the index date (ID). VWD diagnosis (286.4) was required prior to ID and ≥12 month continuous enrollment both prior and post ID. Direct medical costs of TEE management in the first year were estimated for inpatient and outpatient settings. The subset of VWD patients prescribed FRT prior to ID was also described. Costs were adjusted to 2013USD using the medical consumer price index.
Results:
One hundred fifty-three vWD subjects were identified with an inpatient TEE. Mean age at the ID was 56 years (2–94 yrs) and 69.9% were female. Median annual cost and range associated with treatment of TEEs was $21,166 ($1,300–$867,710). VTE and IS were the most common TEEs (36.0% ≥1 VTE, $24,338 ($1,063–$235,090) and 32.7% ≥1 IS, $11,326 ($1,300–$368,550), respectively). Patients prescribed FRT (n=12) had a median annual cost of $64,648 ($4,690–$137,705) for TEE treatment.
Conclusion:
This is the first study to estimate the total cost associated with management of TEEs in vWD. TEEs are a burden to the healthcare system and are potentially life- threatening. A vWD treatment option that can avoid the risk of FVIII accumulation may benefit vWD patients at risk for TEEs.