ENOXAPARIN CO-PAY COSTS FOR PATIENTS RECEIVING EXTENDED DISCHARGE VTE CHEMOPROPHYLAXIS
Christopher Prien*, Dovid Ribakow, Bethany Bandi, Hannah Horne, Samuel Hinckley, Taylor Boice, Nancy Anzlovar, Scott Steele, David Liska, Hermann Kessler, Tracy L. Hull, Stefan D. Holubar
Colon & Rectal Surgery, Cleveland Clinic, Cleveland, OH
Background
Extended discharge chemoprophylaxis represents one means to reduce the risk of postoperative VTE. However, patient costs remain a barrier to more widespread adaptation and compliance. Minimal cost data has been reported, thus we aimed to define the average co-pay cost for an extended discharge enoxaparin regimen.
Methods
IRB exempt status was obtained for this study. Demographic, perioperative, and enoxaparin co-pay data was collected from patient charts, the institutional NSQIP database, and pharmacy price quotes for a select group of patients who underwent colorectal surgery at the institution during 2020-2021 and were discharged on extended VTE chemoprophylaxis. Aspirin cost represents the average online price of a 36-day supply of enteric coated, 81 mg aspirin. Descriptive and one-way ANOVA analyses were performed.
Results
The study included 171 patients (50.8% males, mean age 46 years, mean BMI 26.2) with diagnoses of Crohn's disease in 65 (38.0%), ulcerative colitis in 47 (27.4%), and cancer (colon, rectal, and anal) in 41 (23.9%). The most common operations were ileocolic resection in 40 (23.4%), total abdominal colectomy in 28 (16.3%), and completion proctectomy with IPAA in 13 (7.60%). While hospitalized, 169 (98.8%) patients received VTE chemoprophylaxis. At discharge 136 (79.5%) received enoxaparin and 31 (18.1%) received aspirin as extended chemoprophylaxis. Postoperative VTE developed in 3 (1.7%) patients and 4 (2.3%) patients required transfusion for significant bleeding in the first 30 postoperative days. No patients discharged with aspirin developed VTE or significant bleeding.
Among these patients, 110 (64.3%) had private insurance, 35 (20.4%) had Medicare, 18 (10.5%) had Medicaid, and 8 (4.6%) were self-pay. The co-pay cost of enoxaparin for 160 patients was obtained with an overall mean of $43.35 and range of $0.00 - 277.26. Mean co-pay for those with private insurance was $29.27±55.74, with Medicare was $83.06±79.23, with Medicaid was $7.83±32.98, and self-pay was $168.06±83.07. Primary payer status was found to significantly (p<0.0001) impact co-pay cost. Of those receiving aspirin, 16 did so because they could not afford their enoxaparin co-pay. The mean online cost of a 36-day supply of enteric coated, 81 mg aspirin was $9.75.
Conclusion
We defined the mean co-pay for extended discharge chemoprophylaxis with enoxaparin as $43.35, a cost warranting clinician consideration. Of note, patients with Medicare were charged substantially more than those with private insurance or Medicaid. Aspirin, a more cost-conscious option, may be a safe alternative chemoprophylactic agent which could help improve patient compliance.
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