Incidence and cost burden of post-thrombotic syndrome

Abstract

Post-thrombotic syndrome (PTS) is a long-term complication of deep-vein thrombosis (DVT), manifesting as swelling, pain, edema, venous ectasia, and skin induration of the affected limb. PTS has been estimated to affect 23-60% of individuals with DVT, frequently occurring within 2 years of the DVT episode. Symptomatic DVT, post-operative asymptomatic DVT, and recurrent DVT are all risk factors for the development of PTS. Treatment of PTS is often ineffective and treatment-related costs represent a healthcare burden. Therefore, prevention of DVT is essential to reduce PTS, and thus improve outcomes and reduce overall healthcare costs. Although recommended by guidelines, appropriate DVT prophylaxis remains considerably underused. This review evaluates the incidence, risk factors, and economic impact of PTS. Increasing the awareness of PTS, and the methods to prevent this complication may help reduce its incidence, improve long-term outcomes in patients, and decrease resulting costs associated with treatment.

Figures

Fig. 1

Sequence of events leading to post-thrombotic syndrome. DVT = deep-vein thrombosis. Reproduced from “the post-thrombotic syndrome: current knowledge, controversies, and directions for future research” by SR Kahn & JS Ginsberg, Blood Reviews 16:155-65 copyright 2002, with permission from Elsevier.

Fig. 2

The probability of enoxaparin being cost-effective against the cost-effectiveness threshold for 2 models, including and excluding long-term complications [89]. QALY = quality-adjusted life years. Reproduced from “Results of an economic model to assess the cost-effectiveness of enoxaparin, a low-molecular-weight heparin, versus warfarin for the prophylaxis of deep vein thrombosis and associated long-term complications in total hip replacement surgery in the United States” by Botteman MF, Clinical Therapeutics vol. 24(11):1960-86 copyright 2002, with permission from Elsevier.