VTE - the burden

1. What is the current status of VTE?
2. Why is VTE also known as the silent killer?
3. What does the VITAE study show us with regard to determining the impact of VTE?
4. What is the VTE disease burden in Europe?
5. What is the economic burden of VTE in Europe?
6. What do guidelines tell us?
7. How important is creating awareness?
References

1. What is the current status of VTE?
VTE is a general term that describes the blocking of a blood vessel by a blood clot (thrombus). VTE encompasses pulmonary embolism (PE) and deep-vein thrombosis (DVT) – blood clots that affect the lungs or a deep vein (typically of the leg). In the UK and USA, thromboembolic events such as PE and DVT kill more people than AIDS, breast cancer, prostate cancer, and traffic accidents combined.¹

2. Why is VTE also known as the silent killer?
Estimates on VTE incidence, morbidity and mortality are difficult to assess because events can be complicated to diagnose, often having non-specific clinical signs or being asymptomatic. Studies show VTE can frequently occur as a secondary complication to another medical issue for which the patient is hospitalized. Examining the morbidity of hospitalized patients showed

• of patients undergoing orthopaedic surgery in the UK, 45–51% develop DVT² 
• in the UK, PEs following DVT events in hospitalized patients cause between 25,000 and 32,000 deaths each year²
• it is estimated that across 25 EU countries approximately 0.7 million DVT and 0.4 million PE events occur each year¹

In addition, post-mortems are not routinely performed and therefore VTEs are not always recognized as having been the cause of death.

3. What does the VITAE study show us with regard to determining the impact of VTE? 
The VITAE clinical study showed that blood clots due to venous thrombosis claim over 500,000 lives in the EU each year.¹

Data from the VITAE study demonstrate a clear need for preventative measures, since most premature deaths due to blood clots are avoidable with available effective prophylaxis. If effective prophylaxis is more consistently applied to at-risk patients, a significant rate of fatal cases could be prevented. Therefore, systematic assessment and prophylaxis, if required, should be implemented in all relevant patients.²

4. What is the VTE disease burden in Europe?
The VITAE study estimates a total number of symptomatic VTE events within the six EU countries of approximately 466.000 cases of DVT, 296.000 cases of PE, and 370,000 VTE-related deaths annually and that the annual disease burden of fatal and non-fatal symptomatic VTE, which includes PE and DVT, exceeds 1.5 million events in the 25 countries in the EU. There are approximately 0.7 million DVT events, 0.4 million PE events, and 0.5 million deaths annually.¹

5. What is the economic burden of VTE in Europe?
The VTE burden in Europe includes not only the disease burden but also a significant economic burden. This exceeds a recently published House of Commons Report (UK) that estimated the total direct and indirect cost of managing VTE in the UK to be EUR 0.9 billion (GBP 640 million).² Most patients with VTE require one or more diagnostic tests and treatment, and hospital stay may be prolonged for those who are already hospitalized. Subsequent long-term follow-up care, including regular hospital visits and blood tests, add to the overall financial cost of this condition. Long-term complications, such as PTS and PH, increase costs even further.

The cost to lives, the cost to healthcare providers
VTE is a costly condition which puts a significant burden on both the healthcare system and individuals. The majority of patients with VTE require one or more diagnostic tests, treatment, and prolonged hospital stay (if already hospitalized). Subsequent long-term follow-up care, including regular hospital visits and blood tests, can add to the overall financial costs of this condition. Long-term complications, such as PTS, increase costs even further. As an example, in the UK, the total cost to the healthcare service (direct and indirect) of managing VTE is estimated to be GBP 640 million annually.²

6. What do guidelines tell us?
Pharmacological prophylaxis using blood-thinning drugs (anticoagulant prophylactic treatments) are commonly used to prevent VTE in patients at risk.

One of the most followed set of clinical guidelines in the EU are issued from the British Committee for Standards in Haematology (1998)³ and are based on a literature review from extensive clinical trials. The guidelines recommend pharmacological therapies that can prevent the occurrence of VTE, dependent on the indication, two of which are:

• low-molecular-weight heparins (LMWH)
• low-dose unfractionated heparin (UFH)

Mechanical prophylaxis might also be associated with pharmacological prevention (or used alone in patients for whom anticoagulants are contraindicated). These mechanical measures include

• graduated compression stockings
• intermittent pneumatic compression devices
• venous foot pump

7. How important is creating awareness?
Lack of awareness of VTE within the medical profession can mean patients who are at risk of VTE because of clearly defined risk factors fail to receive appropriate treatment. This can be especially relevant for patients in hospitals, who at the highest risk of developing VTE.²

Patients undergoing major surgery face high risk of VTE – however, an estimated 40% or more of these patients still do not receive an effective form of thromboprophylaxis.⁵ Only 40% of medical at-risk patients eligible for preventive treatment (approximately 25% of all those in hospital for an acute medical condition) receive an effective thromboprophylactic agent.⁶ This underestimation and lack of knowledge leads to insubstantial funding and potential under-treatment of patients at risk of developing VTE.

References

1. Cohen AT et al. Thromb Haemost. 2007;98:756-64
2. House of Commons Health Committee Report on the Prevention of Venous Thromboembolism in Hospitalised Patients. Available at: www.publications.parliament.uk/pa/cm200405/ cmselect/cmhealth/99/9902.html. Last accessed 19 September 2005
3. British Committee for Standards in Haematology. Guidelines on Oral  Anticoagulation (3rd edn.) Update. Brit J Haematol 2005
4. Samama MM et al. N Eng J Med 1999;341:793-800
5. O’Shaughnessy D. VERITY Venous Thromboembolism Registry Second Annual Report 2004. ISBN 1-903968-08-9
6. Cohen AT et al. Lancet 2008;371:387-94