The Cost of Venous Thromboembolism
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VASCULAR DISEASE MANAGEMENT. 2025;22(10):E72-E79
Abstract
Venous thromboembolism (VTE), a common and serious vascular condition, is associated with a substantial economic burden. This review provides on overview of the economic cost of VTE and the factors that drive costs. These factors include the direct medical costs of the initial treatment as well as the indirect costs due to lost productivity and premature death. Complications associated with the initial treatment, as well as chronic complications, including recurrent events, add considerably to total costs. New endovascular therapies might be able to reduce VTE costs by shortening hospital stay and/or reducing short-term, as well as long-term, complications. However, the precise economic impact of these new VTE treatments remains to be clarified. Data comparing the outcomes and costs of new technologies with the standard of care, anticoagulation, as well as direct comparisons between specific devices, are needed.
Introduction
Venous thromboembolism (VTE) is comprised of deep vein thrombosis (DVT) or pulmonary embolism (PE).1 In the United States, annual incidence is 900,000 to 1.2 million.2,3 DVT accounts for approximately 70% of VTE cases.4
VTE is a major cause of morbidity and mortality.4 PE mortality is higher than DVT. Within 1 year of a VTE diagnosis, approximately 20% of individuals die, either from the VTE event or the condition that provoked the event.4 In the United States, VTE results in 60,000 to 300,000 deaths annually.2,5
Patients with VTE incur higher costs than matched controls. One study found that health care costs for patients with VTE were almost 2 times more than matched controls, or $33,531 vs $17,590, respectively. While all medical costs were higher, the difference was primarily driven by hospital costs, which were $10,659 more for patients with VTE.6
VTE is primarily treated in the hospital, particularly PE. The majority of VTE medical costs, or approximately 75%, are inpatient while outpatient accounts for approximately 20% of the total.7
Economic Cost of VTE Is Substantial
Direct medical costs specifically attributable to VTE (incremental costs) are $7 to $10 billion.8 All-cause direct medical costs are $15 to $34 billion.9 Including indirect costs of $6 to $12 billion due to premature life lost, total all-cause costs rise to $21 to $46 billion.9 These figures are comparable to the $37 billion cost of stroke.10
In the above estimates, direct medical costs were defined as the cost of hospital treatment and readmissions for recurrent VTE. Complications included major and minor bleeding and heparin-induced thrombocytopenia, as well as chronic complications of post-thrombotic syndrome (PTS) and chronic thromboembolic pulmonary hypertension (CTEPH).8,9
Although these are the most comprehensive cost estimates that have been published, we believe they are too conservative. This reflects several factors including the impact of inflation, the fact that the estimates were based on older DVT and PE incidence data, and treatment costs were based on older, less-expensive technologies. In addition, nonmedical costs were not included in the incremental cost estimate.8
All-cause costs were reported in 2011 US dollars while incremental VTE costs were reported in 2014 US dollars.8,9 Since 2011, both consumer prices and medical care costs have increased by 43%.11 Simplistically, inflating the $15 to $34 billion in medical costs to 2024 dollars increases the economic cost to $21 to $48 billion.12 Inflating VTE-specific costs to 2024 dollars results in $9 to $13 billion.12
The cost calculations were based on lower DVT and PE incidence data. Incremental VTE costs were calculated based on incidence of 375,000 to 425,000 cases.8 The all-cause cost estimate employed an incidence of 480,000 to 910,000.9 These are considerably lower than the current 900,000 to 1.2 million incidence.2,3
Over the last 10 to 20 years, the cost of VTE treatments has risen.5 This reflects the introduction of direct oral anticoagulants (DOACs), as well as the availability of percutaneous mechanical thrombectomy devices for clot removal.13,14
Even at higher prices, new therapies have the potential to reduce costs. DOACs can decrease total VTE costs by reducing complications and the need for monitoring.13,15 In addition, anticoagulation with DOACs has enabled almost 40% of patients with VTE to be treated in the less expensive outpatient setting.15,16 Utilization of mechanical thrombectomy might decrease treatment cost by reducing hospital stay, intensive care unit (ICU) stay, and bleeding complications, or by decreasing long-term complications.14,17-19
The total economic impact of these more expensive VTE therapies is still being elucidated.
Nonmedical Costs Add to the Economic Burden
Both DVT and PE are associated with significant nonmedical costs, particularly those due to lost productivity.16,20-22 These costs were not included in either of the economic cost estimates.8,9
Nonmedical costs and lost productivity add significantly to the economic burden of VTE. In a prospective Canadian analysis, over half of 2-year DVT costs were nonmedical. By type, almost 60% were due to lost productivity, while caregiving assistance accounted for 32% and transportation for 10% of total costs.16
European studies concluded that lost productivity accounts for approximately half of 1-year VTE costs.21,22 In a US analysis, short-term disability costs for DVT and PE were $58,181 and $48,751, respectively. Long-term disability costs were $7,414 and $7,605 for DVT and PE, respectively.20
PE Outcomes and Costs Vary by Severity and Type of Diagnosis
Analysis of in-hospital outcomes and resource utilization in 371 patients with acute, submassive, and massive PE found that median PE treatment costs were $10,032. However, treatment costs for massive PE were almost 3 times higher than those for submassive, or $23,053 vs $8,508.23 PE severity affected bleeding, mortality, ICU stay, and hospital length of stay (LOS).23
Despite low utilization of thrombolysis, in-hospital bleeding was a frequent adverse event during hospitalization, or 36.6% for massive PE and 9.1% for submassive PE.23
Hospitalizations during which a primary major bleed or an in-hospital death occurred were associated with higher costs ($30,081 vs $7,978) as well as longer LOS and higher frequency of ICU care.23
Patients with PE admitted with a non-VTE diagnosis such as trauma, sepsis/infection, hematology/oncology, non-PE related cardiovascular disease, etc, incurred higher costs. This reflected the combination of the greater cost of care, longer LOS, and more frequent utilization of the ICU, as well as higher incidence of major bleeding and death.23
In-hospital mortality was 7.0%, with the death rate 10 times higher for massive PE than submassive PE (36.6% vs 3.3%).23
Evolution of Minimally Invasive Treatments
In high-risk patients with PE without contraindications, the initial treatment is systemic thrombolysis with tissue-plasminogen activator (tPA). However, systemic thrombolysis is associated with major bleeding, including fatal intracranial hemorrhage. For less severe forms of PE, anticoagulation alone is the recommended treatment. Despite adequate anticoagulation, intermediate-risk patients with PE can experience high mortality rates and chronic complications, such as CTEPH.18
Reflecting the above limitations, PE treatment has evolved to include advanced minimally invasive therapies that have the potential to augment anticoagulation and mitigate the use of systemic thrombolysis and open embolectomy.18,24 The economic cost of these interventional therapies continues to be investigated.
PE Index Procedure Costs
A recent analysis compared the initial, or index, procedure costs of PE interventional therapies at a single academic medical center. At $3,889, initial procedures costs were lowest for catheter-directed thrombolysis (CDT). Costs were highest for aspiration thrombectomy (AT) and mechanical thrombectomy (MT), or $12,126 and $13,748, respectively. Cost of ultrasound CDT (US-CDT) and pharmacomechanical thrombectomy were in the middle, or $9,107 and $9,566, respectively.24
Higher AT and MT costs were driven by materials costs. Reflecting expensive aspiration and mechanical aspiration thrombectomy devices, materials costs accounted for over 80% of total costs in the AT and MT procedures.24
The index procedure was defined as beginning with room preparation and ending at the completion. Costs included personnel, space, equipment, materials, devices, and tPA.24
However, index procedure costs represent only 1 component of the patient cost of any interventional therapy. In order to compare the cost of different PE treatments, total costs should be considered. Total costs include the cost of in-hospital morbidity and mortality, as well as the incidence and cost of chronic complications and unplanned readmissions.8,9,23,25 LOS and the need for an ICU stay are also key factors in the hospital cost of PE treatment.23
Interventional Treatment: Comparison of 30-Day Hospital Costs
A model-based comparison of total 30-day costs for 3 interventional PE treatments found that therapy with the highest-priced device was the least costly. Total costs for MT were $17,290. Device costs accounted for 69% of the total. Higher device costs were offset by shorter hospital stays, less ICU care, and lower use of thrombolytics, as well as fewer 30-day readmissions. Total costs for PE treatment with AT and US-CDT were $20,938 and $19,146, respectively.18
Total costs were defined as device costs, variable acute care costs, and contingent costs. Acute care costs included non-device expenses from procedural care, adjunctive PE procedures, ICU stays, and hospital LOS. Contingent costs included expenses related to the use of thrombolytic medications, major and minor bleeding, and 30-day readmissions. Costs were derived from a systematic literature review.18
Limitations of this analysis include the following: No distinction was made between the cost of high- and intermediate-risk PE or between the costs associated with PE and non-PE diagnosis on admission; complications were limited to bleeding; in-hospital mortality was not included; and acute care and contingent costs were the mean of costs reported during an 18-year time period (2005-2023) during which device technology evolved.18
A multicenter comparison of the total cost of CDT and MT treatment for submassive PE in the 2013 to 2021 period found no significant difference between the 2 therapies. Despite a significant difference in the cost of devices employed, total hospital costs associated with CDT and MT were $73,108 and $71,756, respectively.17
The MT device cost $10,000, or 50% of the procedure cost. The cost per CDT catheter was $78 for the Cragg-McNamara infusion catheter (Medtronic) and $2,595 for the EKOS ultrasound-facilitated thrombolysis system (Boston Scientific). CDT device costs accounted for only 1% and 15% of total procedure costs, respectively.17
In addition to initial procedure costs and hospital utilization, the analysis included complications, imaging, pharmaceutical, laboratory, and in-hospital mortality costs.17
One of the major limitations of this analysis is that costs were those for an 8-year period during which treatments evolved, with an operator learning curve. Over the study period, total costs of both treatments converged, primarily reflecting reduction in LOS and ICU use. In addition, practices varied at the 3 hospitals. Finally, CDT and US-CDT devices were considered to be 1 category for costs and outcomes.17
Neither study included the incidence and cost of chronic complications.17,18
It is important to note that these cost analyses were based on specific company devices and prices.17,18,24 By category, the devices were US-CDT (EKOS system), CDT (Cragg-McNamara), MT (FlowTriever system [Inari Medical]) and AT (Indigo system [Penumbra]). Therefore, costs and outcomes are likely to be different for the many other thrombectomy devices on the market.
Post-PE Syndrome
Post-PE syndrome is a long-term, costly consequence of PE.8,26,27 Resulting from incomplete thrombus resolution after anticoagulant therapy, post-PE syndrome is characterized by dyspnea, clinical and functional impairment, poor quality of life (QOL), and reduced physical performance.28,29
Post-PE syndrome is a spectrum of disease that includes chronic thromboembolic disease (CTED) and CTEPH. While patients with CTED and CTEPH have similar symptoms and impairment, those with CTED do not have resting pulmonary hypertension.29
After an acute PE, post-PE syndrome occurs in 40% to 50% of patients.27 Patients with post-PE syndrome have higher all-cause mortality, higher incidence of rehospitalization, and lower QOL.30 The most severe form, CTEPH, affects approximately 2% to 4% of PE survivors.8,27 CTEPH is associated with very poor QOL and is fatal if untreated.27,29
CTEPH can be treated with pulmonary endarterectomy, balloon pulmonary angioplasty, and/or pulmonary hypertension drugs. However, lack of awareness and other factors significantly delay diagnosis and treatment.26,27
Patients with CTEPH incur higher medical costs and consume more healthcare resources than matched controls.31-33 Even before diagnosis, patients with CTEPH incur higher medical costs.31,33 In the MarketScan database, total costs of patients with CTEPH were nearly 6 times more than those of controls.31 Higher costs reflect greater use of inpatient and outpatient services, as well as increased pharmaceutical costs.31,32
A model-based analysis estimated that total medical costs of patients with CTEPH who underwent successful endarterectomy exceeded $70,000. Costs in those with residual pulmonary hypertension after the procedure were even higher, exceeding $113,000.34
Indirect costs due to lost productivity add significantly to total costs.28 A Swedish study found that lost productivity costs were higher in patients with CTEPH than in matched controls, before and after the diagnosis.33
DVT: Endovascular Technologies
Therapeutic anticoagulation is the standard of care for DVT. While anticoagulation prevents new thrombus formation, it is inadequate at resolving existing thrombus.35,36 Residual venous thrombus, which occurs in 36% to 55% of patients with DVT, predicts PTS, DVT recurrence, and mortality.35 Anticoagulation is also associated with poor long-term outcomes. Approximately 40% to 50% of patients develop PTS, and up to 25% experience recurrent DVT.36,37
Endovascular treatments, which either dissolve thrombus or disrupt and extract thrombus, remove thrombus more effectively than anticoagulation. They also restore blood flow more rapidly and provide immediate symptom relief. Reflecting the above, endovascular technologies have the potential to reduce long-term complications.36,38,39
Comparison of Interventional Treatment Costs
As is the case with PE, device prices significantly impact interventional DVT index procedure costs. A model-based analysis of 30-day hospital costs of DVT treatment found that higher device costs can be offset by fewer complications and lower acute care costs. Data was extracted from a systematic review of the literature published on 4 types of DVT interventional devices.36
Per-patient cost of care was lowest for MT ($10,682), even with device costs of $8,228, or 77% of the total. AT was the second least costly therapy at $14,073 despite device costs of $9,105, or 65% of the total. US-CDT and rheolytic thrombectomy (RT) were associated with the highest total costs, or $16,177 and $19,669, respectively.
Device costs for US-CDT and RT accounted for 36% and 57% of the total costs, respectively. Key factors influencing the higher costs of US-CDT and RT were the cost of complications (bleeding and acute kidney injury), readmissions, greater acute care costs, and use of tPA.36
A real-world comparison of 3 interventional DVT treatments also found differences in clinical outcomes and resource utilization based on the type of device used. MT had the lowest total hospital cost, or $29,549. The MT device was associated with lower in-hospital mortality and resource use.39
In contrast to the results of the model-based analysis that employed historic cost data, total hospital costs of RT were lower than those of AT, or $33,701 vs $42,705. Costs and outcomes were derived from 4,455 DVT procedures performed from 2018 to 2022 in the PINC AI health care database, formerly known as the Premier health care database.39
In addition to total costs, hospital resource utilization included data on intraprocedural thrombolytics use, blood transfusion, LOS, and ICU stay. Safety outcomes included all-cause in-hospital mortality and all-cause 30-day inpatient readmission.39
As with interventional PE treatment, these comparative DVT analyses were based on specific company devices at specific prices. By category, the devices were US-CDT (EKOS system), RT (AngioJet ZelanteDVT system [Boston Scientific]), MT (ClotTriever system [Inari Medical]), and AT (Indigo system).36,39 Therefore, costs and other outcomes are likely to differ with the other thrombectomy devices currently available.
Costs of chronic complications, such as PTS and venous ulcers, were not included.36,39 The cost of long-term complications (recurrent DVT or PTS) is 75% or more of the cost of the primary DVT.40,41 Therefore, including the incidence and cost of PTS and other chronic complications associated with different interventional treatments would add considerably to our understanding of total DVT costs.
Data comparing the incidence of PTS after treatment with endovascular therapy with anticoagulation are mixed. While several trials concluded that CDT does not reduce PTS, preliminary data indicate that treatment with MT might do so.42-46
Post-Thrombotic Syndrome
PTS significantly increases total DVT costs. This reflects the high rate of occurrence combined with annual medical costs of almost $56,000.47,48
Approximately, 20% to 50% of patients with DVT develop PTS.47 PTS is a chronic condition with limited treatment options.49 The most common symptoms are limb pain, aching, fatigue, heaviness, cramping, and/or edema.49 Approximately 5% to 10% of patients have severe PTS, which includes severe pain, venous claudication, uncontrolled edema, and/or venous ulcers.50
A patient with DVT and PTS incurs higher medical costs and consumes more health care resources than one without.41,48 Even before diagnosis, medical costs are higher for those who develop PTS than controls.48
One study found that after adjustment for comorbidities and patient characteristics, total costs for a patient with DVT and PTS were 32% higher than for a patient without PTS, or $47,596 vs $35,929, respectively. Reflecting a greater incidence of comorbidities, patients with DVT and PTS also incurred higher costs before the index VTE event.48
In total hip replacement patients, a model-based analysis found that those who developed severe PTS (ulcers) had lifetime costs that were 19 times higher than controls. Lifetime costs for patients with mild-to-moderate PTS were 15 times higher than those of controls.41
Venous ulcers are the most expensive consequence of PTS. Rice and colleagues found that the all-cause medical costs of venous ulcers were $18,986 for Medicare patients and $15,296 for privately insured patients. Per-patient incremental costs of venous ulcers were $2,611 and $3,066 for Medicare and privately insured patients, respectively. In addition, privately insured patients incurred costs due to lost productivity of $2,481.51
Unplanned Readmissions
Unplanned readmissions drive up costs. Thirty-day unplanned VTE readmissions are 17.5%, ranging from 15.8% for PE to 19.4% for DVT. Patients with both DVT and PE are readmitted at a rate of 14.3%.25
Total hospital costs for a readmitted patient with VTE were over twice as high as those for a patient who did not require readmission, or $24,521 vs $10,573, respectively. Based on the median per-patient cost of $9,782, the national cost of VTE readmissions totaled $1.44 billion.25
Readmissions are often fatal, with a higher in-hospital mortality rate than that of the initial admission, or 8.1% vs 6.2%, respectively.25
Predictors and causes of readmission were primarily associated with patient characteristics and complications related to comorbid conditions. At 8.1%, procedural complications are one of the most frequent causes of unplanned readmissions. Other causes include sepsis (9.6%), issues related to malignancy (6.7%), recurrent DVT (5.1%), and pulmonary heart disease (4.3%).25
Recurrent VTE Adds to Costs
VTE is highly recurrent. Within 1 year, 4% to 15% recur.7,52 At 10 years, the recurrence rate is 33%.2 Recurrent VTE events add to total costs.7,52
Patients with a recurrent VTE cost more than those without. An analysis of the Truven MarketScan database found that Medicare patients with a recurrent VTE incurred higher annual costs than those without, or $55,982 vs $31,203, respectively. Costs for commercial patients with a recurrent VTE were even higher, or $82,110 vs $36,918 for those without recurrence. Greater use of inpatient care was the key factor driving up costs.7
A recurrent VTE costs more than the initial, or index, episode. Analysis of the Premier hospital database found that recurrent VTE events were associated with 22% higher costs than the index event. Patients with a recurrent VTE had more all-cause hospitalizations, more all-cause emergency department visits, and a 14% longer LOS than those without a recurrent VTE.52
VTE in Patients With Cancer
Patients with cancer are an important subset of VTE, accounting for about 20% of new cases.53 VTE increases cancer patient treatment costs by almost 2 times. Compared with matched controls, costs for a patient with cancer and VTE were $49,351 vs costs of $26,529 for those without VTE.54
Cancer is one of the strongest risk factors for a recurrent VTE, increasing the risk by over 2 times.52 As might be expected, a recurrent VTE increases health care costs in those with cancer. One study found that costs in cancer patients with a recurrent VTE were almost twice as high as costs in those with no recurrence or $84,708 vs $44,903, respectively.55
Conclusion
The economic costs of VTE are considerable. Incremental costs specifically attributable to VTE are $7 to $10 billion.8 Total all-cause costs are estimated at $21 to $46 billion.9
However, these cost estimates are conservative and should be updated with more current data. This reflects several factors including the impact of inflation since publication, the fact that the estimates were based on lower DVT and PE incidence data, and that treatment costs were based on older, less-expensive technologies. In addition, costs of lost productivity, which are substantial, were not included.
New endovascular technologies have the potential to decrease VTE costs by reducing hospital stay, ICU stay, and bleeding complications, and/or by decreasing chronic complications. However, the economic impact of these minimally invasive treatments remains to be clarified.
A complete economic evaluation should compare the outcomes and costs of new technologies with the standard of care, anticoagulation, as well as include direct comparisons of specific devices. In addition to total hospital costs, economic data should include costs of chronic complications, such as PTS and post-PE syndrome, as well as VTE recurrence and unplanned readmissions. A comprehensive assessment of the economic impact of VTE should also include the costs of lost productivity and premature death. Comparative data should be collected at intervals out to at least 2 years. n
Affiliations and Disclosures
Mary Yost, MBA, is president and cofounder of The Sage Group. The Sage Group is a for-profit research and consulting company specializing in peripheral artery disease and chronic and acute venous disease. The following companies have been clients in the last 2 years:
Research Clients: Angiodynamics, Becton Dickinson, enVVeno Medical, Gore, Philips, Shockwave, Veryan
Consulting Clients: Janssen, Shockwave
Manuscript accepted August 19, 2025.
Address for correspondence: Mary L. Yost, MBA, The Sage Group LLC, Beaufort, South Carolina. Email: yost@thesagegroup.us
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