Prevalence and economic burden of pulmonary embolism in Germany.

The prevalence of pulmonary embolism (PE), PE mortality and treatment-associated costs for the years 2000 to 2006 were analysed using a statutory health insurance sample of AOK Hesse/KV Hesse, which contained information for an 18.75% random sample of 1.9 million persons insured with the AOK Hesse. Within the sample a PE diagnosis was accepted as valid if it was documented as the main discharge diagnosis or as an additional hospital diagnosis during hospitalization and if at least one of the following criteria was met: prescription of oral anticoagulants or heparins, PE documented for at least two quarterly periods or documented in only one quarter for patients who died within 28 days after hospital discharge. The economic burden from the perspective of the insurance fund was assessed by an analysis of resource consumption (direct costs) and by a matched pair analysis with controls without PE to estimate excess costs. A 99% winsorization of each cost category was performed to control for extreme outlying values. The prevalence of PE as the main discharge diagnosis and an additional hospital diagnosis varied from 55.3 to 71.7 per 100,000 insurants in the years 2000 to 2006. Insurants aged 80 years and more had a prevalence of 406.9 per 100,000 (year 2006). From 2001 to 2003 the in-hospital mortality rate ranged from 20.4% to 24.9% and decreased to 14% in 2006. A total of 85% of all patients with PE who survived the first year had at least one prescription of vitamin K antagonists. For patients who survived the first year, treatment costs exceeded € 20,000, with an estimation of additional costs of € 5816 for men and € 8962 for women in the matched-pair analysis. Owing to high in-hospital costs, the overall cost of treatment was highest for patients younger than 60 years. In conclusion, the prevalence rate of PE in Germany is comparable to international data. Treatment costs within the first year after hospital discharge are high, and there is a need to clarify the settings associated with PE in Germany with its high rate of prophylaxis.

Cost associated with D-Dimer screening for acute aortic dissection.

INTRODUCTION: D-Dimer (DD) has been described as a useful predictor of both morphologic changes in acute thoracic aortic dissection (TAD) and of TAD-associated mortality. This study analyzed the use of DD screening to screen patients with chest pain for acute (TAD) to determine if it improves diagnosis and cost effectiveness. This study also looked at the association of DD levels with diagnoses frequently seen in patients with dyspnea or chest pain. METHODS: At the Helios Hospital, Krefeld, the authors analyzed the data of all patients (n = 1053, age (mean, SD) 62 ± 19 years, 49% males) admitted for chest pain to the nonsurgical emergency department (ED) in February 2010. Chest pain was the second most frequent symptom causing 138 (13.1%) admissions, 102 of which had DD testing (Inniovance® D-Dimer Assay, Dade Behring/Siemens, Germany). To assess the diagnostic reliability of DD testing, the sensitivity, specificity, and odds ratio, including 95% confidence interval, were estimated. RESULTS: None of the patients admitted were found to have acute TAD. Had the authors used a computerized tomography (CT) scan to rule out TAD in every patient with chest pain, actual costs would have been euro 12,328. A restriction of CT scans to patients with elevated DD levels would have lowered costs to euro 5360. The actual costs were euro 670.30 for CT scans and euro 540.60 for DD tests. On analyzing the association with other diagnoses, both sensitivity and specificity were low, with the exception of pneumonia. CONCLUSION: Owing to the low incidence of TAD, DD screening increases diagnostic efforts and costs but it remains unclear whether it would actually speed up TAD diagnosis. In a clinical setting DD did not help to discriminate other relevant diagnoses. Despite the high sensitivity of DD for aortic dissection published in the literature, the physician's clinical judgment remains paramount.