Prevalence of Venous Thromboembolism in Cancer Patients in the Emergency Department and associated Healthcare Resource Utilization and Expenditure in the United States (Abstract # 101335) Yu-Wei Chen MD MS1, Min-Jung Wang MS2, Alok A. Khorana MD3 1Deparment of Internal Medicine, Cleveland Clinic Foundation 2Department of Epidemiology, Harvard T. H. Chan School of Public Health 1Taussig Cancer Center, Cleveland Clinic Foundation

Methods/NEDS database Sponsored by the Agency for Healthcare Research and Quality and is part of the Healthcare Cost and Utilization Project (HCUP). HCUP is derived from administrative data originally collected for billing purposes. Discharge data for ED visits from 945 hospitals located in 33 States and D.C. approximating 20 % stratified sample of US hospital-based EDs largest ED database in the US Imaging studies of interests were identified with CPT codes VTE diagnosis was identified with Clinical Classifications Software (CCS) based on ICD-9 CM. https://www.hcup-us.ahrq.gov/nedsoverview.jsp

Results: Patient Characteristics Age Median (IQR) 70 (58-80) Sex (%) Male 2,960,102 (47) Female 3,369,367 (53) Cancer Types (%) Prostate 864,540 (14) Breast 1145,538 (18) Lung 825,368 (13) Colorectal 756,463 (12) Pancreas 103,521 (1.6) Head and Neck 184,173 (2.9) Continued Esophagus 81,349 (1.3) Stomach 81,111 (1.3) Hepatobiliary 93,162 (1.5) Kidney 191,471 (3) Bladder 263,939 (4) Thyroid 87,290 (1.3) Leukemia 280,955 (4.4) Lymphoma 374,713 (5.9) Multiple Myeloma 116,644 (1.8) Other 880,055 (14)

Results: Trends in Use of Imaging Studies 2.5 1.6 % of the cancer patients had imaging studies which could lead to diagnosis of VTEs Any 2 2.5-fold Computed tomography pulmonary angiography (CTPA): 0.56% CT chest with contrast (CTC): 0.47% Duplex ultrasound of the veins (DUS): 0.62% Ventilation-Perfusion (VQ) scan: 0.02% 1.5 CTPA 1 DUS CTC 0.5 VQ 2006 2007 2008 2009 2010 2011 2012 CTPA DUS V/Q CTC Any

Results: Rates of Admission and Mortality In Patients With and Without VTE % of Admission by VTE Status % of Mortality by VTE Status 100 8 7 6 5 4 3 2 1 80 60 40 20 2006 2007 2008 2009 2010 VTE No VTE 92% vs 61%, p-value< .0001 2011 2012 2006 2007 2008 2009 VTE No VTE 2010 2011 2012 6.5% vs 4%, p-value< .0001 *AOR: 6.7, 95% CI: 6.54-6.80, p-value: <.0001 *AOR: 1.25, 95% CI: 1.23-1.28, p-value< .0001 *Models were adjusted for age, sex and cancer types

Results: Total Hospital Costs In Patients With and Without VTE 40,000 35,000 $8,000 USD 30,000 25,000 MVA for higher total hospital costs (≥75th ) 20,000 15,000 AOR: 2.37, 95% CI: 2.34-2.40, P-value: <.0001 10,000 *Model was adjusted for age, sex and cancer types 5,000 2006 2007 2008 2009 2010 2011 2012 VTE No VTE 2006 2007 2008 2009 2010 2011 2012 VTE 26,069 27,238 29,683 31,471 33,068 33,791 34,254 No VTE 19,013 19,497 21,807 22,670 23,973 25,044 26,768

Conclusions From 2006-2012, there was a 2.5-fold increase of imaging studies use in cancer patients in the ED, suggesting increased awareness of VTE by ED providers. The prevalence of VTE among cancer patients in ED visits is 2.35% (top 3: pancreas, lung, stomach). VTE diagnosis in ED is an independent predictor for higher rate of hospital admission, mortality, and healthcare-associated costs among cancer patients. Ongoing trials of outpatient thromboprophylaxis in cancer patients will hopefully reduce the burden of VTE in cancer patients, and if successful, reduce ED visits, admissions, morbidity and mortality