1. Prevalence of Venous Thromboembolism in Cancer Patients in the Emergency Department and associated Healthcare Resource Utilization and Expenditure in the United States
(Abstract # )
Yu-Wei Chen MD MS1, Min-Jung Wang MS2, Alok A. Khorana MD3
1Deparment of Internal Medicine, Cleveland Clinic Foundation 2Department of Epidemiology, Harvard T. H. Chan School of Public Health 1Taussig Cancer Center, Cleveland Clinic Foundation

2. Methods/NEDS database
Sponsored by the Agency for Healthcare Research and Quality and is part of the Healthcare Cost and Utilization Project (HCUP).
HCUP is derived from administrative data originally collected for billing
purposes.
Discharge data for ED visits from 945 hospitals located in 33 States and D.C.
approximating 20 % stratified sample of US hospital-based EDs
largest ED database in the US
Imaging studies of interests were identified with CPT codes
VTE diagnosis was identified with Clinical Classifications Software (CCS) based on ICD-9 CM.

3. Results: Patient Characteristics
Age
Median (IQR)
70 (58-80)
Sex (%)
Male
2,960,102 (47)
Female
3,369,367 (53)
Cancer Types (%)
Prostate
864,540 (14)
Breast
1145,538 (18)
Lung
825,368 (13)
Colorectal
756,463 (12)
Pancreas
103,521 (1.6)
Head and Neck
184,173 (2.9)
Continued
Esophagus
81,349 (1.3)
Stomach
81,111 (1.3)
Hepatobiliary
93,162 (1.5)
Kidney
191,471 (3)
Bladder
263,939 (4)
Thyroid
87,290 (1.3)
Leukemia
280,955 (4.4)
Lymphoma
374,713 (5.9)
Multiple Myeloma
116,644 (1.8)
Other
880,055 (14)

4. Results: Trends in Use of Imaging Studies
2.5
1.6 % of the cancer patients had imaging studies which could lead to diagnosis of VTEs
Any 2
2.5-fold
Computed tomography pulmonary angiography (CTPA): 0.56%
CT chest with contrast (CTC): 0.47%
Duplex ultrasound of the veins (DUS): %
Ventilation-Perfusion (VQ) scan:
0.02%
1.5
CTPA 1
DUS
CTC
0.5 VQ
CTPA DUS V/Q CTC Any

5. Results: Rates of Admission and Mortality In Patients With and Without VTE
% of Admission by VTE Status
% of Mortality by VTE Status
100 8 7 6 5 4 3 2 1 80 60 40 20
2006
VTE No VTE
92% vs 61%, p-value< .0001
2011
2012
2006
2007
2008
2009
VTE No VTE
2010
2011
2012
6.5% vs 4%, p-value< .0001
*AOR: 6.7, 95% CI: , p-value: <.0001 *AOR: 1.25, 95% CI: , p-value< .0001
*Models were adjusted for age, sex and cancer types

6. Results: Total Hospital Costs In Patients With and Without VTE
40,000
35,000
$8,000 USD
30,000
25,000
MVA for higher total hospital costs (≥75th )
20,000
15,000
AOR: 2.37, 95% CI: , P-value: <.0001
10,000
*Model was adjusted for age, sex and cancer
types
5,000
2006
2007
2008
2009
2010
2011
2012
VTE
No VTE
2006
2007
2008
2009
2010
2011
2012
VTE
26,069
27,238
29,683
31,471
33,068
33,791
34,254
No VTE
19,013
19,497
21,807
22,670
23,973
25,044
26,768

7. Conclusions
From , there was a 2.5-fold increase of imaging studies use in cancer patients in the ED, suggesting increased awareness of VTE by ED providers.
The prevalence of VTE among cancer patients in ED visits is 2.35% (top 3: pancreas, lung, stomach).
VTE diagnosis in ED is an independent predictor for higher rate of hospital admission, mortality, and healthcare-associated costs among cancer patients.
Ongoing trials of outpatient thromboprophylaxis in cancer patients will hopefully reduce the burden of VTE in cancer patients, and if successful, reduce ED visits, admissions, morbidity and mortality