Economic burden of major bleeding events in commercially insured patients with von Willebrand disease based on claims data from the United States

Abstract

BACKGROUND: von Willebrand disease (VWD) can lead to serious, life-threatening bleeding events associated with substantial clinical and economic burden. OBJECTIVE: To estimate the prevalence, health care resource utilization (HCRU), and costs associated with major bleeding events in patients with VWD. METHODS: This was a retrospective analysis of the IBM MarketScan database (2008-2016). Selected patients had ≥2 VWD diagnoses, no diagnosis of acquired coagulation factor deficiency, and continuous health care plan enrollment for ≥12 months from eligibility start date. Prevalence was calculated as the proportion of eligible patients with ≥1 major bleeding event during the observation period (start to end of continuous eligibility). HCRU and costs in the 12-month continuous enrollment period following the first major bleeding event were compared with those from a comparable 12-month period for patients without major bleeding events. RESULTS: Of the 19,785 patients with VWD, 15% experienced ≥1 major bleeding event during a median follow-up of 4 years; 89% of these events were gastrointestinal bleeds. For the economic analysis, 773 patients with ≥1 major bleeding event and 4,285 patients without major bleeding events met the selection criteria. Controlling for baseline covariates, patients with major bleeding events had significantly (P<0.0001) more inpatient admissions (incidence rate ratio [IRR]=3.2; 95% CI=2.78-3.77), longer inpatient stays (IRR=3.9; 95% CI=3.12-4.93), and more emergency department visits (IRR =2.0; 95% CI=1.77-2.27) and outpatient visits (IRR=1.3; 95% CI=1.19-1.34) than patients without major bleeding events. Annual health care costs were significantly higher (P<0.01) for patients with major bleeding events than those without them (predicted mean cost differences: total=$20,890, pharmacy=$2,593, and medical=$18,293). CONCLUSIONS: Major bleeding events were associated with increased HCRU and costs, mostly inpatient costs. Therefore, optimizing therapy to prevent or reduce major bleeding events has the potential to reduce health care use and costs in patients with VWD.