Understanding Medication Adherence Using Stated-Preference Data

Understanding Medication Adherence Using Stated-Preference Data

A492 VA L U E I N H E A LT H 1 7 ( 2 0 1 4 ) A 3 2 3 – A 6 8 6 unknown risk cohort (n= 2,497; 86 days). The annual indirect cost related to work p...

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unknown risk cohort (n= 2,497; 86 days). The annual indirect cost related to work productivity loss was estimated at 209,704 SEK for treated hyperlipidemia patients with CV event history. Corresponding data for CV RE patients and patients at low/ unknown risk were 168,517 SEK and 108,429 SEK, respectively. The higher CV risk levels were associated with greater productivity losses. Indirect costs varied within cohorts depending on past diagnoses of the patients. In patients with CV event history, a previous diagnosis of myocardial infarction was associated with the lowest annual indirect costs (189,114 SEK) while a past diagnosis of ischemic stroke was associated with the highest indirect costs (281,985 SEK). Within the CV RE cohort, a previous diagnosis of abdominal aortic aneurysm and transient ischemic attack was associated with the highest (264,441 SEK) and lowest annual indirect costs (156,254 SEK), respectively.  Conclusions: The high level of productivity losses illustrates the high indirect cost burden in patients treated for hyperlipidemia. The type of past CV event affected the level of indirect costs. PCV111 Health Care Costs Associated With Cardiovascular Events In Patients With Hyperlipidemia - Estimates From Population-Based Register Data In Sweden Hallberg S 1, Banefelt J 1, Mesterton J 1, Gandra S R 2, Fox K M 3, Johansson G 4, Levin L Å 5, Sobocki P 6 1Quantify Research, Stockholm, Sweden, 2Amgen, Inc., Thousand Oaks, CA, USA, 3Strategic Healthcare Solutions, LLC, Monkton, MD, USA, 4Uppsala University, Uppsala, Sweden, 5Linköping University, Linköping, Sweden, 6IMS Health, Stockholm, Sweden .

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Objectives: To estimate annual incremental health care costs of new cardiovascular (CV) events (myocardial infarction, unstable angina, revascularization, ischemic stroke, transient ischemic attack or heart failure) in patients with hyperlipidemia or prior CV events.  Methods: A retrospective population-based cohort study was conducted using Swedish electronic medical records and national registers. Patients were included in the study based on a prescription of lipid-lowering treatment between January 1, 2006 and December 31, 2006 or history of CV events (prior to 2006) and followed until December 31, 2012 for identification of new CV events and estimation of cost. Patients were stratified into three cohorts based on CV risk level. Propensity score matching was applied to compare patients with new events to patients without new events and to estimate incremental costs.  Results: A new CV event resulted in increased costs during all follow-up years. Inpatient hospital stays were the main driver of the increase. The majority of the costs occurred in the first year following event when patients with CV event history (n= 6,881) had an incremental cost of 74,758 SEK. This was similar to that of CV risk-equivalent patients (n= 3,226; 75,415 SEK) and patients at low/unknown CV risk (n= 2,497; 72,635 SEK). Ischemic stroke resulted in the highest first year cost in all cohorts (88,739; 85,516; and 87,668 SEK) and transient ischemic attack the lowest (34,098; 36,042; and 29,052 SEK). Incremental costs during subsequent years remained elevated for all cohorts, with the CV event history cohort having the highest costs. Second year incremental costs varied between 10,689 and 15,082 SEK and third year costs varied between 8,828 and 11,558 SEK across cohorts.  Conclusions: The direct costs of new CV events were substantial and varied considerably by type of event. Costs were increased during all follow-up years, regardless of CV risk level. PCV112 Inpatient Case-Related Treatment Costs For Different Cardiovascular Diseases In Germany Schädlich P K 1, Rosenfeld S 2, Reindl S 3, Kotowa W 3 Institut GmbH, Berlin, Germany,, 2Sanofi-Aventis Deutschland GmbH, Berlin, Germany,, 3IGES Institut GmbH, Nuremberg, Germany .

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1IGES

Objectives: As part of a non-interventional study, hospitalizations due to the following diagnoses of cardiovascular disease (CVD) were documented: atrial fibrillation (AF), stroke or TIA (SoT), acute coronary syndrome (ACS), arterial embolism (AE), decompensated heart failure (DHF), syncope (S), ventricular arrhythmia (VA), and cardiac arrest (CA). The objective of this cost analysis was to quantify inpatient treatment costs for each diagnosis in Germany from the perspective of the statutory health insurance.  Methods: The analysis was conducted for 2012 using the latest available “G-DRG V2013 Browser 2012 § 21 KHEntgG”. Invoiced diagnosis-related groups (DRGs) including the ICD10-codes corresponding to the considered diagnoses were collected. For available DRGs, the number of cases with normal length of stay and the corresponding cost weights (CWs) were documented. Then, the proportion of an individual DRG within a diagnosis (≥ 1 ICD10-code) was calculated (number of cases for individual DRG / sum of all cases for every DRG within a diagnosis =  “DRG weight factor”). Next, the CWs of an individual DRG were multiplied by the “DRG weight factor” to reflect the prevalence of a DRG within an ICD10-code (“weighted CWs”). Finally, the “weighted CWs” were added up to obtain an average CW for a diagnosis, which is based on all DRGs and CWs coded for this single diagnosis. This sum of CWs was multiplied by the state-wide base rate of 2,991.53€ .  Results: The following inpatient treatment costs for the respective diagnoses were derived: 2,800€  (AF); 5,000€  (SoT); 5,200€  (ACS); 6,200€  (AE); 3,800€  (DHF); 1,900€  (S); 8,200€  (VA); 15,900€  (CA) (rounded).  Conclusions: Inpatient treatment costs for the considered CVD diagnoses vary from 1,900€  to 15,900€ . Generally, hospitalizations due to CVD have a remarkable impact on the budget of German sick funds. The results of this cost study can be used for further health economic analyses in CVD. PCV113 Clinical Pathway And Health Care Resources Utilization Of A Patients Cohort At High Risk Of Cardiovascular Disease Of Local Health Care Unit (Asln°1) Of Milan: A Results Of Intervention On Secondary Prevention Di Matteo S 1, Colombo G L 2, Malnis D 3, Bruno G M 1 e Valutazioni economiche, Milan, Italy, 2University of Pavia, Milan, Italy, 3Dipartimento Governance asl Milano1, Rho, Italy .

1S. A. V. E. Studi Analisi

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Objectives: The objective of the project is to evaluate the impact of health care resources and the related health care costs in relation to outcomes occurred in 10 years on the cohort of 2002 and intervention on secondary prevention cohort 2010 with a follow-up to 3 years.  Methods: In 2002, Local HealthCare Unit (ASLn°1) of Milan identified a cohort of 33,977 patients with RCV (Cardiovascular risk). Data analysis was done trough a retrospective claims data study from ASLn°1 of Milan; Physicians who participated were 494. Information has been collected for inclusion in the study regarding some risk factors and treatment. At the end of 2010, all recruited patients were started on a program of secondary prevention, by reducing the effects of smoking and BMI after ad hoc training events for physicians.  Results: 12,000 subjects were recruited and followed for 3 years with reduction of spending on the NHS system and reduced incidence of events. A resources utilization analysis has been developed using profiles of treatments and dividing the population into groups with homogeneous treatment (smoking and BMI control vs. standard care), verifying the occurrence of greater outcomes and related health care costs. Data are analyzed with the definition of major cardiovascular events, all-cause mortality and cause-specific, occurrence of diabetes and other chronic greater diseases, verifying the occurrence of greater outcomes and related health care costs.  Conclusions: Administrative databases offer low-cost information (since they are already available) regarding more or less all services provided in a health care environment. These sources and their integration are a powerful tool supporting conventional methods used in epidemiological studies and as tools for plan Health care policy.

Cardiovascular Disorders – Patient-Reported Outcomes & Patient Preference Studies PCV114 Cardiovascular Risk, Gender And Medication Adherence In Rural Area Of Vietnam Nguyen T P L , CCM S V , Postma M J University of Groningen, Groningen, The Netherlands .

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Objectives: To examine the relationship between medication compliance, cardiovascular risk and gender in hypertensive patients visiting primary health care centers.  Methods: A prospective 1-year study was conducted in rural communes in Vietnam on hypertension management in a population from 35 to 64 years. Data on age, gender, blood pressure and blood test were collected at baseline. Cardiovascular risk was based on the Cardiovascular Risk Prediction Model for populations in Asia. Medication compliance was calculated as the number of days taking the drug divided by the number of days since the first day of the prescription. A threshold of 80% was applied to differentiate between compliance or non-compliance. Taking medication was based on patients’ self-report during each monthly visit.  Results: Of total 338 patients met the selection criteria for medication compliance study, 46% was female. Mean age was 53.5 (+/- 6.9) and 77.2 % of patients was <  10% of CVD risk in 8 years. In primary health care settings, medication compliance was 49%. No significant difference in medication compliance in both CVD risk groups (< 10% vs. > 10% risk) was found, also not after controlling for age and gender (adjusted OR was 1.27; 95 % CI: 0.7 – 2.2; p value 0.39). The odds of medication compliance in females was however 0.6 times higher than in males (95% CI: 0.38 to 0.95, p value 0.028). Each 1 year increase, results in patients being 1.04 times more likely to be compliant (95% CI: 1.009 to 1.076, p value 0.01).  Conclusions: Medication compliance rate was low among hypertensive patients in Vietnam. CVD risk at the baseline did not significantly differentiate complaint from non-compliant patients. Yet, a major difference in compliance was found for gender. Rather than risk profile, gender should be considered for guiding the choice on who to target for improving medication compliance for hypertensive patients. PCV115 Health Behavior And Medication Adherence Han E 1, Sohn H S 2, Jang S 3 University, Incheon, South Korea, 2Sookmyung Women’s University, Seoul, South Korea, 3Inje University, Gimhae, South Korea .

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1Yonsei

Objectives: To explore the associations of selected health behaviors with medication adherence in elderly patients aged 65+ years with hypertension, diabetes, or hyperlipidemia.  Methods: The Korean National Health Insurance data between January 2010 and June 2011 were used. The study included 662,170 hypertensive, 179,285 diabetic, and 244,702 hyperlipidemic patients. Poor medication adherence was defined as <  80% medication possession ratio from January to June 2011. Health behavior data were from year 2010. Multivariate logistic regression was used.  Results: Patients with a waist circumference <  85 (for women) or 90 (for men) centimeters were more likely to adhere to their medications. Current smokers and moderate or heavy drinkers showed poor medication adherence than their counterparts. Mild physical activity was associated with better medication adherence.  Conclusions: Public efforts need to focus on improving comprehensive control of both health behaviors and medication adherence. PCV116 Understanding Medication Adherence Using Stated-Preference Data González J M 1, Poulos C 1, Mollon P 2 1RTI Health Solutions, Research Triangle Park, NC, USA, 2Novaris Pharma AG, Basel, Switzerland .

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Objectives: More than half of people who have experienced a myocardial infarction (MI) are not adherent to their medication regimen, which leads to poorer health outcomes. We used a stated-preference (SP) study to examine factors that could influence patient compliance to prophylactic cardiovascular treatments, and discuss practical issues in using SP methods to explain medication adherence.  Methods: Preference data for treatments that lower the risk of cardiovascular events were collected from 464 respondents in the United States with self-reported history of MI using a discrete-choice experiment (DCE). All respondents answered 11 judgment



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questions that presented a pair of virtual patients who were prescribed different treatments defined by: reduction in the risks of nonfatal MI and fatal MI, treatment-related risk of serious infection, mode and frequency of administration, and monthly medication cost. Half of the choice questions asked respondents to select the treatment to which they would most likely be nonadherent. The other half asked respondents to state which of two virtual patients was better off after learning how adherent each was to each medication. Limited dependent-variable models were used to estimate weights indicating the impact of treatment and respondent characteristics on stated-adherence and quantifying the stated impact of nonadherence on respondents’ well-being.  Results: Results indicated that reductions in the risk of a nonfatal MI had the largest effect on stated adherence, followed by medication cost, the risk of serious infection, and lastly mode and frequency of administration. Results also show that reductions in compliance had a significant impact on the perceived overall benefits of prophylactic treatments.  Conclusions: We find that both clinical and nonclinical factors can impact treatment adherence, suggesting that the flexibility to include a variety of factors with SP models can be useful in understanding patient compliance. PCV117 Patient Adherence Among Adolescents With Arterial Hypertension Nowakowska E , Paczkowska A , Bryl W , Hoffmann K Poznan University of Medical Sciences, Poznan, Poland .

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PCV118 Health State Utilities In Chronic Heart Failure In The Uk Nafees B 1, Cowie M R 2, Patel C 1, Deschaseaux C 3, Brazier J 4, Lloyd A J 5 1ICON plc, Oxford, UK, 2Imperial College London, London, UK, 3Novartis Pharma AG, Basel, Switzerland, 4University of Sheffield, Sheffield, UK, 5Oxford Outcomes, An ICON plc Company, Oxford, UK .

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Objectives: Previous research has shown the impact of chronic heart failure (CHF) on health-related quality of life (HRQL). Less is known regarding the impact of reduced ejection fraction (HFrEF) on HRQL. The aim of this study was to elicit utility values for CHF with HFrEF or preserved ejection fraction (HFpEF) by New York Heart Association (NYHA) classification system in the UK. In addition, utility values for events such as stroke, myocardial infarction (MI) and chronic kidney disease (CKD) were estimated.  Methods: Health states were developed from concept elicitation interviews with CHF patients (N= 10) and cardiologists (N= 5). Draft health states were validated in cognitive debrief interviews with different patients (N= 5) and cardiologists (N= 4) and finalised with scientific input from experts. The resulting health states (n =  10) were piloted with general public to check understanding. General public participants (n= 100) completed background questions and rated each state using visual analogue scale and time trade-off (TTO) assessments (with lead time method for states worse than dead).  Results: The mean TTO utility for HF-rEF ranged between 0.86 (SD= 0.19) (NYHA class II); 0.60 (SD= 0.23) (NYHA III) to 0.28 (SD= 0.41) (NYHA IV). Equivalent values for HF-pEF were 0.83 (SD= 0.24) (NYHA II); 0.55 (SD= 0.28) (NYHA III) to 0.27 (SD= 0.35) (class IV) respectively. Other values were post hospitalisation after stroke (mean= 0.30, SD= 0.43); post MI (mean= 0.45, SD= 0.37) and CKD (mean= 0.78, SD= 0.21). Post-hospitalisation states captured a period of upto three months after the event.  Conclusions: This study shows the effect that NYHA class has on HRQL for people with CHF in the UK. The findings showed that HFrEF and HFpEF were very similar. Participants considered events such as recovery from stroke to have significant impact on HRQL. These are important data to consider in evaluating outcomes of treatments and should be reflected in cost effectiveness models in CHF where relevant. PCV119 Acute And Chronic Impact Of Cardiovascular Events On Health State Utilities Matza L S 1, Devine M K 1, Gandra S R 2, Delio P R 3, Fenster B E 4, Davies E 5, Jordan J1, Lothgren M6, Feeny D H 7 1Evidera, Bethesda, MD, USA, 2Amgen, Inc., Thousand Oaks, CA, USA, 3Neurology Associates of Santa Barbara, Santa Barbara, CA, USA, 4National Jewish Health, Denver, CO, USA, 5Evidera, London, UK, 6Amgen (Europe) GmbH, Zug, Switzerland, 7University of Alberta, Portland, OR, USA .

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PCV120 Health State In Patients With Atrial Fibrillation On New Oral Anticoagulants As Assessed With The New Eq-5d-5l Questionnaire At Baseline And 12-Month Follow-Up: Prefer In Af Registry Brüggenjürgen B 1, Schliephacke T 2, Darius H 3, De Caterina R 4, Le Heuzey J Y 5, Reimitz P E 2, Schilling R J 6, Schwertfeger M 2, Zamorano J L 7, Kirchhof P 8 1Steinbeis University Berlin (SHB), Berlin, Germany, 2Daiichi Sankyo Europe GmbH, Munich, Germany, 3Vivantes Hospital Neukölln, Berlin, Germany, 4G. d’Annunzio University, Chieti, Italy, 5Hôpital Européen Georges Pompidou, Université René Descartes, Paris, France, 6Barts and St Thomas Hospital, London, UK, 7University Hospital Ramón y Cajal, Madrid, Spain, 8University of Birmingham Centre for Cardiovascular Sciences and SWBH NHS Trust, Birmingham, UK .

Objectives: The aim of the study was to assessment of compliance by adolescents in the field of pharmacological and non-pharmacological methods of hypertension treatment. Methods: The study included 62 patients (20 women, 42 men) diagnosed with hypertension and treated in specialist health care facilities. As a research tool was used questionnaire prepared on the basis of recent literature.  Results: The vast majority of respondents (72,7%) declared that regularly taking antihypertensive drugs. The proportion of patients regularly taking antihypertensive drugs was higher in patients treated with monotherapy than polytherapy (48,5% vs 24,2%). Among the methods of non-pharmacological treatment of hypertension the most accepted lifestyle change in the study population was smoking cessation (83,8% of respondents) and reduction of salt consumption (64,5% of respondents), and the least acceptable lifestyle change was to maintain proper body weight by eating a low calorie diet (30,6% of respondents).  Conclusions: Adolescents with hypertension in varying degrees adhere to a medical recommendations related to the hypertension treatment. From the available literature data indicate that the current effective way to improve cooperation with the patient’s is education.

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recovery; post-event health states represented chronic impact. UK general population respondents valued the health states in time trade-off tasks with time horizons of one year for acute states and ten years for chronic states.  Results: A total of 200 participants completed interviews (55% female; mean age =  46.6y). Among acute health states, stroke had the lowest utility (0.33), followed by heart failure (0.60) and ACS (0.67). Utility scores for chronic health states followed the same pattern: stroke (0.52), heart failure (0.57), and ACS (0.82). For stroke and ACS, acute utilities were significantly lower than utilities for chronic post-event (difference =  0.20 and 0.15, respectively; both p <  0.0001).  Conclusions: Results add to previously published utilities for cardiovascular events by distinguishing between chronic post-event health states and acute health states that include the event and its immediate impact. Findings suggest that acute and chronic impact should be considered when selecting scores for use in cost-utility models. Thus, the current utilities provide a unique option that may be used to represent the acute and chronic impact of cardiovascular conditions in economic models comparing treatments that may delay or prevent the onset of cardiovascular events.

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Objectives: Cost-utility models are frequently conducted to compare treatments intended to prevent or delay cardiovascular events. Most published utilities represent post-event health states without incorporating the disutility of the event or reporting the time between the event and utility assessment. Therefore, the objective of this study was to estimate health state utilities representing cardiovascular conditions while distinguishing between acute impact including the cardiovascular event and the chronic post-event impact.  Methods: Health states were drafted and refined based on literature review, clinician interviews, and a pilot study. Three cardiovascular conditions were described: stroke, acute coronary syndrome (ACS), and heart failure. One-year acute health states represented the event and gradual

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Objectives: We aimed to understand the short-term impact on quality of life associated with Non VKA Oral AntiCoagulants (NOACs) use in patients with AF. We obtained baseline (BL) and follow-up (FU) data on the health state of AF patients under everyday practice conditions in the PREvention oF thromboembolic events – European Registry in Atrial Fibrillation (PREFER in AF).  Methods: PREFER in AF documents AF patients in terms of clinical characteristics, management, quality of life and other outcome parameters. The EuroQol EQ-5D-5L descriptive system and visual analogue scale (VAS) were applied in PREFER in AF at BL and FU to obtain patient-reported generic health-related quality of life information and utility weights.  Results: Of the 6390 AF patients at follow-up 1895 (29.7%) had paroxysmal, 1533 (24.0%) persistent, 474 (7.4%) long-standing persistent, and 2488 (38.9%) permanent AF. Comorbidities were highly prevalent. 3344 AF patients (61.1% males, mean age 71.7 ± 9.85 years) provided EQ-5D-5L data both at BL and 12-month FU. On the VAS (range 0-100), the mean score at FU was 68.8 ±18.1 points, with no major differences between patients on NOACs (68.3), VKAs (68.9), AP (70.1), or VKA+AP (71.7), respectively. All scores improved from baseline from 0.36 in patients on VKA to 1.77 for those on AP. The overall utility index at FU was 0.80 ±0.21. At FU the 409 patients on NOACs had a utility score of 0.79 (change from BL, -0.01), the 1789 patients VKAs 0.80 (-0.01), the 237 patients on AP 0.81 (+0.01), the 151 patients on VKA and AP 0.80 (-0.01) and the 749 patients receiving neither VKAs nor AP 0.80 (0.00).  Conclusions: Patients with AF present with reduced self-reported quality of life compared to the general population. Patients receiving NOACs had similar quality of life both at baseline and after 12-month FU, when compared to alternative medications. PCV121 Health State In Patients With Venous Thromboembolism On Conventional And Non-Vka Oral Anticoagulants As Assessed With The Eq-5d-5l Questionnaire: Prefer In Vte Registry Cohen A T 1, Bauersachs R 2, Gitt A K 3, Mismetti P 4, Monreal M 5, Willich S N 6, Wolf W P 7, Agnelli G 8 1King’s College, London, UK, 2Max-Ratschow-Klinik für Angiologie, Gefäßzentrum Klinikum Darmstadt GmbH, Darmstadt, Germany, 3Herzzentrum Ludwigshafen, Ludwigshafen, Germany, 4Centre Hospitalier Universitaire Saint-Etienne, Hopital Nord, Saint Etienne, France, 5Hospital Universitari Germans Trias I Pujol, Barcelona, Spain, 6Charité - Universitätsmedizin Berlin, Berlin, Germany, 7Daiichi Sankyo Europe GmbH, Munich, Germany, 8University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy .

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Objectives: Non-VKA oral anticoagulants (NOAC), which do not need routine monitoring, have the potential to improve the quality of life (QoL) in patients on long-term treatment for venous thromboembolism (VTE). We aimed to obtain contemporary data on the health state of patients with VTE under daily practice conditions.  Methods: PREFER in VTE is a non-interventional study in 7 countries (France, Germany, Austria, Switzerland, Italy, Spain, UK) that prospectively documents patients after an event of acute deep venous thrombosis (DVT) or pulmonary embolism (PE) in terms of clinical characteristics, management, quality of life and other outcome parameters. The EuroQol EQ-5D-5L consists of the 5-dimension descriptive system used to derive utility scores and the visual analogue scale (VAS), measuring self-rated health (scale 0-100).  Results: A total of 2790 patients with acute VTE at baseline (BL: 1640 DVT, 1150 PE ±DVT) and 723 patients at an interim analysis at 6 months (443 DVT and 280 PE ±DVT) completed the EQ-5D-5L. On the EQ VAS for current health state, the mean score at 6 months was 73.8 points (change from BL +10.9), with similar values in DVT patients (74.6, change from BL +9.8) compared to PE patients (72.4, change from BL +12.4). Between BL and 6-month follow-up, index values increased in all medication classes (heparin only: 0.66 to 0.75; heparin/VKA: 0.70 to 0.84; NOAC: 0.73 to 0.87). Overall the index value increased from 0.69 to 0.83 (DVT: 0.71 to 0.85, PE: 0.67 to 0.81).  Conclusions: Under clinical practice conditions, patients on NOAC and heparin/VKA had larger increases in their health state scores than those on heparin only. This generic QoL tool detected only small differences between treatment options. Six months after the event, patients with DVT had similar self-reported QoL on the VAS compared to patients with PE, and patients with DVT had somewhat higher utility values.