0
Original Investigation |

Estimating Quality of Life in Acute Venous Thrombosis

Kerstin Hogg, MBChB; Miriam Kimpton, BA; Marc Carrier, MD; Douglas Coyle, PhD; Melissa Forgie, MD; Philip Wells, MD
JAMA Intern Med. 2013;173(12):1067-1072. doi:10.1001/jamainternmed.2013.563.
Text Size: A A A
Published online

Importance Future funding for new treatments in venous thromboembolism will be guided by cost-utility analyses. There is little available information on the utility of acute venous thromboembolism, limiting the validity of economic analyses.

Objective To measure the quality of life in the health states relating to thromboembolism cost-utility analyses.

Design A prospective cohort study.

Setting A single-center, university-affiliated thrombosis clinic.

Participants Two hundred sixteen thrombosis clinic patients with a history of lower limb deep vein thrombosis (DVT) or pulmonary embolism (PE).

Exposures Participants consented to take a standard gamble interview. Each participant rated the quality of life in acute DVT, acute PE, and bleeding complication health states.

Main Outcomes and Measures The standard gamble measured quality of life (utility value) for acute DVT, acute PE, major intracranial bleeding event, minor intracranial bleeding event, and gastrointestinal bleeding event.

Results Two hundred fifteen responses were included in the analysis. Twenty-six percent had experienced both PE and DVT; 54%, DVT alone; and 20%, PE alone. Forty-two percent had experienced more than 1 episode of thrombosis, and 23% had had cancer-associated thrombosis. We found the median utility for acute DVT was 0.81 (interquartile range [IQR], 0.55-0.94); acute PE, 0.75 (IQR, 0.45-0.91); major intracranial bleeding event, 0.15 (IQR, 0.00-0.65); minor intracranial bleeding event, 0.75 (IQR, 0.55-0.92); and gastrointestinal bleeding event, 0.65 (IQR, 0.15-0.86). The median length of symptoms for DVT or PE was 1 week (IQR, <1-3 weeks).

Conclusions and Relevance To our knowledge, this is the largest published study on utilities in which the participants had personal experience of venous thromboembolism. We present unique information for economic analyses but have also identified future challenges for research in this area. Our summary results differ from those previously published, and we found wide variation in individual responses.

Figures in this Article

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

Figures

Place holder to copy figure label and caption
Graphic Jump Location

Figure 1. Health state descriptions.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 2. Visual aid for standard gamble with which patients rate their severe stroke health state. The participant should choose between staying in the stroke health state or else taking the offered treatment, which has a 70% probability of cure and a 30% probability of immediate and painless death.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 3. Utility results for pulmonary embolism.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 4. Utility results for deep vein thrombosis.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 5. Utility results for major intracranial bleeding event.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 6. Utility results for minor intracranial bleeding event.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 7. Utility results for gastrointestinal bleeding event.

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 2

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
PubMed Articles
Chronic myeloproliferative diseases. Handb Clin Neurol 2014;120():1073-81.
Jobs
JAMAevidence.com

Users' Guides to the Medical Literature
Deep Venous Thrombosis

Users' Guides to the Medical Literature
Scenario 2

brightcove.createExperiences();