Real-world economic burden of venous thromboembolism and antithrombotic prophylaxis in medical inpatients.

INTRODUCTION: Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in medical patients, and the economic burden of this disease is plausibly relevant as well. However, few data from real-world observations are available on this topic. Aim of our study was to assess the costs of VTE management and antithrombotic prophylaxis in patients hospitalized in Internal Medicine (IM) departments. MATERIALS AND METHODS: The in-hospital paths of 160 patients with VTE (VTE group) and 160 patients receiving prophylaxis and without VTE (NO-VTE group) were retrospectively evaluated within 26IM units in Italy. The economic analysis was undertaken by applying a process analysis, the initial phase of the more comprehensive Activity Based Costing technique. Accordingly to this approach, only information closely linked to VTE or its prevention was registered. RESULTS: The total median costs for VTE management were around four-times higher than those for prophylaxis (€ 1,348.68 vs € 373.03). Human resources were the most important cost-driver (55.5% and 65.7% in the VTE and NO-VTE groups), followed by instrumental (24.6% in VTE and 15.5% in NO-VTE) and haematologic tests (12.6% in VTE patients and 13.3% in controls). In the NO-VTE group the direct costs for prophylaxis accounted for 4.5% of total. CONCLUSIONS: The real-world data of this study confirm the economic burden of in-hospital treatment of VTE, and the relatively low costs of thromboprophylaxis. A greater adherence to evidence-based protocols for VTE prevention could probably reduce the current financial burden of VTE on healthcare systems.

Pain assessment in non-communicative patients: the Italian version of the Non-Communicative Patient's Pain Assessment Instrument (NOPPAIN).

BACKGROUND AND AIMS: Although pain in the elderly is a common and important problem, it is frequently underestimated and undertreated. Pain assessment in elderly people is often more difficult than in the general population, because of the occurrence of dementia and other cognitive impairments that may compromise the ability to communicate the presence and the intensity of pain to hospital staff. Recently, several observational tools have been developed in order to assess pain behaviors in non-communicative patients. The aim of the present study was to verify if the Italian version of the Non- Communicative Patient's Pain Assessment Instrument (NOPPAIN) could be used in a hospital setting. METHODS: Sixty severely demented patients (MMSE /=23, language test score >/=4) were selected on the basis of their cognitive status and language skills. NOPPAIN forms were filled in at the same time by two nursing staff members after patients' daily care activities; behavioral indicators of the affective state and communicative patients' reports of pain were also collected. RESULTS: Significant interrater agreement was found in the subscores of the four main sections of the NOPPAIN and also in the total score. In addition, in cognitively intact patients there was a moderate (about 0.50) but significant correlation between NOPPAIN ratings and pain self-reports. A positive correlation between pain scores and negative affective state scores was also found, especially in cognitively impaired patients. CONCLUSIONS: The preliminary data of the present study support the reliability and validity of the Italian version of the NOPPAIN, which appears to be an easy-to-use tool in the assessment of pain in hospitalized non-communicative patients.