Estimating Quality of Life in Acute Venous Thrombosis Estimating QOL in Acute Venous Thrombosis

Hogg K, Kimpton M, Carrier M, et al. — Mon, 20 May 2013 00:00:00 GMT

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.

Quality of Life, Utilities, Quality-Adjusted Life-years, and Health Care Decision Making Comment on “Estimating Quality of Life in Acute Venous Thrombosis” QOL, Utilities, QALYs, & Health Care Decisions

Owens DK, Shekelle PG. — Mon, 20 May 2013 00:00:00 GMT

Of what importance is knowing how patients assess the quality of life (QOL) of health states when trying to make decisions about health care? Consider the case of routine prophylaxis of hospitalized medical patients to prevent venous thromboembolism. In a recent review sponsored by the Agency for Healthcare Research and Quality, Lederle et al pooled data from more than a dozen randomized trials comparing the use of heparin with no heparin. They found that the best estimate was that use of heparin prophylaxis was associated with 2 fewer cases of symptomatic deep vein thrombosis and 4 fewer cases of pulmonary embolism per 1000 patients, but an increase in 9 cases per 1000 of bleeding events, of which 1 case per 1000 patients was a “major” bleeding event. How is a clinician to balance these benefits and harms? The Clinical Guidelines Committee of the American College of Physicians (on which we have both served) made the assumption that most patients would decide that the benefits from reduction in deep vein thrombosis and pulmonary embolus would outweigh the harms associated with bleeding complications, and therefore recommended that hospitalized medical patients (without stroke) receive heparin prophylaxis. But was this assumption correct? The answer rests in part on how patients view the QOL of health states associated with venous thromboembolism and complications of therapy.

JAMA Internal Medicine: Vascular Medicine Topic Collection

Estimating Quality of Life in Acute Venous Thrombosis Estimating QOL in Acute Venous Thrombosis

Quality of Life, Utilities, Quality-Adjusted Life-years, and Health Care Decision Making Comment on “Estimating Quality of Life in Acute Venous Thrombosis” QOL, Utilities, QALYs, & Health Care Decisions