Articles

Cost Analysis of Diagnosis and Treatment of Venous Thromboembolism in Total Knee Replacement Patients

Abstract

Background: Venous thromboembolism (VTE) is a condition that occurs when a blood clot forms in a vein. It includes deep vein thrombosis (DVT) and pulmonary embolism (PE). VTE treatment incurs substantial costs, and it is predicted that the economic burden of this disease on society will continue to rise both domestically and globally. This study aimed to analyze the costs associated with the diagnosis and treatment of VTE in patients undergoing total knee replacement in order to identify major cost drivers and provide insights for more efficient healthcare management.
Methods: An incidence-based approach was used in this cross-sectional descriptive study to perform the cost analysis of diagnosis and treatment of VTE in total knee replacement patients in Iran in 2023. To this end, direct costs were calculated based on the bottom-up costing approach.
Results: The average direct medical cost per patient was $1742.65. The average direct non-medical cost per patient was estimated at $604.75. Notably, 44% of these costs are associated with patient companionship, while 33% are attributed to transportation costs.
Conclusion: With the elderly population on the rise in our country, the need for knee joint replacement surgeries is on an upward trajectory as well. However, it is associated with the risk of developing VTE, which can be severe and life-threatening. Moreover, patients who develop VTE after major orthopedic surgeries tend to have considerably longer hospital stays, placing a strain on hospital resources and finances.

1. Shams M, Samavat T, Hojatzadeh A, Afkhami A, Mahdavi A, Bashti S, et al. Ways of Prevention and Control of Cardiovascular Diseases. Tehran: Press Javan; 2013. [Persian].
2. Aslan A, Khorami R, Rezaii J, Godarzi M, Abbasi Dolatabadi Z. Drug updates for prevention and treatment of venous thromboembolism in orthopedic surgeries. Iranian Journal of Cardiovascular Nursing. 2017;6(2):66-73. [Persian].
3. Beckman MG, Abe K, Barnes K, Bartman B, Brady PJ, Hooper WC. Strategies and partnerships toward prevention of healthcareassociated venous thromboembolism. J Hosp Med. 2016;11 Suppl 2:S5-7. doi: 10.1002/jhm.2659.
4. Le Sage S, McGee M, Emed JD. Knowledge of venous thromboembolism (VTE) prevention among hospitalized patients. J Vasc Nurs. 2008;26(4):109-17. doi: 10.1016/j.jvn.2008.09.005.
5. Diamantopoulos A, Lees M, Wells PS, Forster F, Ananthapavan J, McDonald H. Cost-effectiveness of rivaroxaban versus enoxaparin for the prevention of postsurgical venous thromboembolism in Canada. Thromb Haemost. 2010;104(4):760-70. doi: 10.1160/th10-01- 0071.
6. Glynn RJ, Rosner B. Comparison of risk factors for the competing risks of coronary heart disease, stroke, and venous thromboembolism. Am J Epidemiol. 2005;162(10):975-82. doi: 10.1093/aje/kwi309.
7. Jha AK, Larizgoitia I, Audera-Lopez C, Prasopa-Plaizier N, Waters H, Bates DW. The global burden of unsafe medical care: analytic modelling of observational studies. BMJ Qual Saf. 2013;22(10):809-15. doi: 10.1136/bmjqs-2012-001748.
8. Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D,
Galiè N, et al. Corrigendum to: 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2015;36(39):2666. doi: 10.1093/eurheartj/ehv131.
9. Heisen M, Treur MJ, Heemstra HE, Giesen EB, Postma MJ. Costeffectiveness analysis of rivaroxaban for treatment and secondary prevention of venous thromboembolism in the Netherlands. J Med Econ. 2017;20(8):813-24. doi: 10.1080/13696998.2017.1331912. 10. House of Commons Health Committee. The Prevention of Venous
Thromboembolism in Hospitalised Patients. London: The Stationery Office; 2005.
11. Centers for Disease Control and Prevention (CDC). Venous thromboembolism in adult hospitalizations - United States, 2007-2009. MMWR Morb Mortal Wkly Rep. 2012;61(22):401-4.
12. Sharif-Kashani B, Mohebi-Nejad A, Abooturabi SM. Estimated prevalence of venous thromboembolism in Iran: prophylaxis still an unmet challenge. Tanaffos. 2015;14(1):27-33.
13. Jefferson T, Demicheli V, Mugford M, Baranpourian F. Economic Evaluation of Health Care Services. Tehran: Higher Institute for Social Research. 2007.
14. Abutorabi A, Haj Ahmadi M, Bagheri Faradonbeh S, Rashki Kemmak A, Alipour V. Cost-effectiveness rivaroxaban versus enoxaparin for prevention of venous thromboembolism after knee replacement surgery in Iran. Med J Islam Repub Iran. 2023;37:20. doi: 10.47176/ mjiri.37.20.
15. Aghazadeh S, Nemati M, Sharif Nia E, Hamishehkar H. The cost benefit of drugs and medical consumables in common global gynecological surgeries of two educational-therapeutic hospitals of Tabriz city. J Mod Med Info Sci. 2017;3(2):49-55.
16. Lefebvre P, Coleman CI, Bookhart BK, Wang ST, Mody SH, Tran KN, et al. Cost-effectiveness of rivaroxaban compared with enoxaparin plus avitamin K antagonist for the treatment of venous thromboembolism. J Med Econ. 2014;17(1):52-64. doi: 10.3111/13696998.2013.858634.
17. Nutescu EA, Shorr AF, Farrelly E, Horblyuk R, Happe LE, Franklin M. Burden of deep vein thrombosis in the outpatient setting following major orthopedic surgery. Ann Pharmacother. 2008;42(9):1216-21. doi: 10.1345/aph.1L135.
18. Dobesh PP. Economic burden of venous thromboembolism in hospitalized patients. Pharmacotherapy. 2009;29(8):943-53. doi: 10.1592/phco.29.8.943.
19. Spyropoulos AC, Lin J. Direct medical costs of venous thromboembolism and subsequent hospital readmission
rates: an administrative claims analysis from 30 managed care organizations. J Manag Care Pharm. 2007;13(6):475-86. doi: 10.18553/ jmcp.2007.13.6.475.
20. Vekeman F, LaMori JC, Laliberté F, Nutescu E, Duh MS, Bookhart BK, et al. Risks and cost burden of venous thromboembolism and bleeding for patients undergoing total hip or knee replacement
in a managed-care population. J Med Econ. 2011;14(3):324-34. doi: 10.3111/13696998.2011.578698.
Files
IssueVol 9 No 4 (2025) QRcode
SectionArticles
DOI https://doi.org/10.18502/htaa.v9i4.20663
Keywords
Cost Analysis Direct Medical Cost Direct Non-Medical Cost Venous Thromboembolism

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Alizadeh siuki H, Shobeiri N, Adel A, Rashki kemmak A. Cost Analysis of Diagnosis and Treatment of Venous Thromboembolism in Total Knee Replacement Patients. Health Tech Ass Act. 2025;9(4).