Estimation of the Direct Cost of Management of Venous Thromboembolism in Three Reference Hospitals in the City of Yaoundé: A Retrospective Study over a Three-Year Period
Background: Venous thromboembolism (VTE) is a major public health problem due to its
increasing frequency, mortality and management cost. This cost may require
major financial efforts from patients, especially in developing countries like
ours where less than 7% of the population has health insurance. This study
aimed to estimate the direct cost of managing VTE in three reference hospitals
in Yaoundé. Methods: This was a cross-sectional retrospective study over
a three-year period (from January 1st 2018 to December 31 2020) carried out in
the Cardiology departments of the Central and General Hospitals, and the
Emergency Centre of the city of Yaoundé. All patients managed during the study
period for deep vein thrombosis and pulmonary embolism confirmed by venous ultrasound coupled with Doppler and computed tomography pulmonary angiography respectively were included.
For each patient, we collected sociodemographic and clinical data as well as
data on the cost of consultation, hospital stay, workups and medications. These
data were analysed using SPSS version 23.0. Results: A total of 92
patient’s records were analysed. The median age was 60 years [48 - 68]
with a sex ratio of 0.53. The median direct cost of management of venous
thromboembolism was 766,375 CFAF [536,455 - 1,029,745] or $1415 USD. Management of pulmonary embolism associated with deep
vein thrombosis was more costly than isolated pulmonary embolism or deep vein
thrombosis. Factors influencing the direct cost of management of venous
thromboembolism were: hospital structure (p = 0.015), health insurance (p < 0.001), type of pulmonary
embolism (p = 0.021), and length of hospital stay (p = 0.001).Conclusion: Management of VTE is a major
References
[1]
Nkoke, C., Teuwafeu, D., Mapina, A. and Nkouonlack, C. (2019) A Case Series of Venous Thromboembolic Disease in a Semi-Urban Setting in Cameroon. BMC Research Notes, 12, Article No. 40. https://doi.org/10.1186/s13104-019-4092-8
[2]
Etoundi, P.O., Esiéne, A., Bengono, R.B., Amengle, L., Ela, A.A. and Minkande, J.Z. (2015) La maladie thromboembolique veineuse. Aspects épidémiologiques et facteurs de risque dans un hopital camerounais. Health Sciences and Diseases, 16, 1-4.
[3]
Moheimani, F. and Jackson, D.E. (2011) Venous Thromboembolism: Classification, Risk Factors, Diagnosis, and Management. ISRN Hematology, 2011, Article ID: 124610. https://doi.org/10.5402/2011/124610
[4]
Nkoke, C., Tchinde, N.M.J., Atemkeng, F., Teuwafeu, D., Boombhi, J. and Menanga, A. (2020) Incidence of Venous Thromboembolism, Risk Factors and Prophylaxis in Hospitalized Patients in the South West Region of Cameroon. Vascular Health and Risk Management, 16, 31-24. https://doi.org/10.2147/VHRM.S205935
[5]
Simeni, N.S.R., Nganou-Gnindjio, C.N., Ba, H., Boombhi, J., Ahmadou, M.J., Kuate, M.L., et al. (2019) épidémiologie de le maladie veineuse thromboembolique à Yaoundé: Etude transversale en Afrique subsaharienne. La Revue de Médecine Interne, 40, A186.
https://doi.org/10.1016/j.revmed.2019.03.254
[6]
Guo, J.D., Rajpura, J., Hlavacek, P., Keshishian, A., Sah, J., Delinger, R., et al. (2020) Comparative Clinical and Economic Outcomes Associated with Warfarin versus Apixaban in the Treatment of Patients with Venous Thromboembolism in a Large U.S. Commercial Claims Database. Journal of Managed Care & Specialty Pharmacy, 26, 1017-1026. https://doi.org/10.18553/jmcp.2020.19311
[7]
Pessinaba, S., Atti, Y.D.M., Baragou, S., Pio, M., Afassinou, Y., Kpélafia, M., et al. (2017) L’embolie pulmonaire au centre hospitalier universitaire Campus de Lomé (Togo): Etude rétrospective à propos de 51 cas. The Pan African Medical Journal, 27, Article No. 129. https://doi.org/10.11604/pamj.2017.27.129.6855
[8]
Owoundi, J.P. (2013) Poids des Dépenses de Santé sur le Revenu des Ménages Cameroun. 27 p.
https://iussp.org/sites/default/files/event_call_for_papers/Busan%20Papier%20Final_Poids%20des%20D%C3%A9penses%20de%20Sant%C3%A9_Revenu%20des%20M%C3%A9nages_Cameroun.pdf
[9]
ECAMV22 (1996) Distribution des revenus et consommation des ménages au Cameroun. http://catalog.ihsn.org/index.php/catalog/6038/download/73787
[10]
Okolouma, A. (2018) La réforme de la protection sociale au Cameroun: Vers un changement de logique d’extension de la couverture sociale. Revue Francaise des Affaires Sociales, No. 4, 189-209. https://doi.org/10.3917/rfas.184.0189
[11]
Diall, I., Coulibaly, S., Minta, I., Ba, H., Diakite, M., Sidibe, N., et al. (2011) Causes, Signs and Outcomes of 30 Patients with Pulmonary Embolus. Le Mali Medical, 26, 3-6.
[12]
Enyegue, M. and Bertin, A. (2021) Prévalence de la Maladie Veineuse Thromboembolique au service de Réanimation du centre hospitalier universitaire Gabriel Touré. Thèse de medicine, Université des Sciences Technique et des Technologie de Bamako, Bamako, 86 p.
[13]
Palud, L., Laurent, M., Guéret, P., Meunier, C., Garin, E., Po, B., et al. (2004) Value of the Association of D-Dimer Measurement and the Evaluation of Clinical Probability in a Non-Invasive Diagnostic Strategy of Pulmonary Embolism. Archives des Maladies du Coeur et des Vaisseaux, 97, 93-99.
[14]
Nkoke, C., Tchinde, N.M.J., Atemkeng, F., Teuwafeu, D., Boombhi, J. and Menanga, A. (2020) Incidence of Venous Thromboembolism, Risk Factors and Prophylaxis in Hospitalized Patients in the South West Region of Cameroon. Vascular Health and Risk Management, 16, 317-324. https://doi.org/10.2147/VHRM.S205935
[15]
Coulibaly, S., Menta, I., Diall, I.B., Ba, H.O., Diakité, M., Sidibé, S., et al. (2018) Maladie Thromboembolique Veineuse dans le Service de Cardiologie du CHU du Point G à Bamako. Health Sciences and Diseases, 19, 27-30.
[16]
Hodkinson, K.E. and Mahlangu, J.N. (2017) Deep-Vein Thrombosis in the Era of High HIV and Tuberculosis Prevalence: A Prospective Review of Its Diagnosis and Treatment in a Quaternary Centre. South African Medical Journal, 107, 859-863.
https://doi.org/10.7196/SAMJ.2017.v107i10.12443
[17]
Spencer, F.A., Emery, C., Joffe, S.W., Pacifico, L., Lessard, D., Reed, G., et al. (2009) Incidence Rates, Clinical Profile, and Outcomes of Patients with Venous Thromboembolism. The Worcester VTE Study. Journal of Thrombosis and Thrombolysis, 28, 401-409. https://doi.org/10.1007/s11239-009-0378-3
[18]
Fanikos, J., Rao, A., Seger, A.C., Carter, D., Piazza, G. and Goldhaber, S.Z. (2013) Hospital Costs of Acute Pulmonary Embolism. The American Journal of Medicine, 126, 127-132. https://doi.org/10.1016/j.amjmed.2012.07.025
[19]
Goldstein, L.N. and Wu, M.-T. (2018) A One Year Audit of Patients with Venous Thromboembolism Presenting to a Tertiary Hospital in Johannesburg, South Africa. African Journal of Emergency Medicine, 8, 12-15.
https://doi.org/10.1016/j.afjem.2017.08.006
[20]
Fofana, D., Maiga, A.K., Sanogo, S., Diallo, S., Doumbia, C.T., Sidibe, S., et al. (2019) Facteurs de Risque et Pronostic de la Maladie Veineuse Thromboembolique dans le Service de Cardiologie du CHU Mère-Enfant (CHU-ME) le Luxembourg. Health Sciences and Diseases, 20, 1-3.
[21]
Bullano, M.F., Willey, V., Hauch, O., Wygant, G., Spyropoulos, A.C. and Hoffman, L. (2005) Longitudinal Evaluation of Health Plan Cost per Venous Thromboembolism or Bleed Event in Patients with a Prior Venous Thromboembolism Event during Hospitalization. Journal of Managed Care Pharmacy, 11, 663-673.
https://doi.org/10.18553/jmcp.2005.11.8.663
[22]
Spyropoulos, A.C. and Lin, J. (2007) Direct Medical Costs of Venous Thromboembolism and Subsequent Hospital Readmission Rates: An Administrative Claims Analysis from 30 Managed Care Organizations. Journal of Managed Care Pharmacy, 13, 475-486. https://doi.org/10.18553/jmcp.2007.13.6.475
[23]
Hansson, P.O., Sorbo, J. and Eriksson, H. (2000) Recurrent Venous Thromboembolism after Deep Vein Thrombosis: Incidence and Risk Factors. Archives of Internal Medicine, 160, 769-774. https://doi.org/10.1001/archinte.160.6.769
[24]
Abah, J.P., Menanga, A., Mbatchou, B.H., Minkande, J.Z., Akono, M.N. and Kingue, S. (2016) Pattern of Venous Thromboembolic Diseases in a Resources-Limited Setting in Cameroon. The Pan African Medical Journal, 23, Article No. 236.
https://doi.org/10.11604/pamj.2016.23.236.7034
[25]
Dobesh, P.P. (2009) Economic Burden of Venous Thromboembolism in Hospitalized Patients. Pharmacotherapy, 29, 943-953. https://doi.org/10.1592/phco.29.8.943
[26]
Annemans, L., Robays, H., Bruart, J. and Verstraeten, P. (2002) Variation in Medical Resource Utilisation in the Management of Pulmonary Embolism in Belgium. Acta Clinica Belgica, 57, 11-18. https://doi.org/10.1179/acb.2002.004
[27]
Clay, E., Jamotte, A., Verhamme, P., Cohen, A.T., Van Hout, B.A. and Gumbs, P. (2018) Cost-Effectiveness of Edoxaban Compared to Warfarin for the Treatment and Secondary Prevention of Venous Thromboembolism in the UK. The Journal of Market Access & Health Policy, 6, Article ID: 1495974.
https://doi.org/10.1080/20016689.2018.1495974
[28]
Yang, L. and Wu, J. (2020) Cost-Effectiveness of Rivaroxaban Compared with Enoxaparin plus Warfarin for the Treatment of Hospitalised Acute Deep Vein Thrombosis in China. BMJ Open, 10, e038433.
https://doi.org/10.1136/bmjopen-2020-038433