**3.2.3 Epidemiology**

104 Deep Vein Thrombosis

Given this to be the situation in the developed countries, the the magnitude of the problem would be much lower in the developing countries. Indeed many population studies that are carried in Western developed countries documented the lower incidence of VTE in Asians

Although there is strong evidence that the prevalence of venous thrombo-embolism (VTE) varies significantly among different ethnic/racial groups, the genetic, physiologic and/or

Identifying the scale of DVT in developing countries is difficult due to scanty and conflicting available published literature on the scale of the problem, the diagnostic tools, management and treatment challenges facing these countries. Most published information on the DVT was generated from small hospital-based studies that documented DVT as a significant complication of orthopedic surgery particularly total knee arthroplasty (Chung et al 2010, Ko et al. 2003, Leizorovicz et al 2005, Sen et al 2011, Sen et al 2011), and general hospital patients (Ogeng'o et al 2001, Angchaisuksiri et al 2007, Sakon et al. 2006, Lee et al. 2009). Essentially all these and other similar studies advocated the importance of

As to population studies very few could be identified and almost all from Asian Far Eastern countries particularly China and Korea. In one study from Korea the incidence of VTE, DVT and PE per 100,000 individuals was found to be 8.83, 3.91 and 3.74 in 2004 and increased to 13.8, 5.31 and 7.01 in 2008 (Jang et al 2001). Another recent study from Hong Kong documented an annual incidence of of VTE at 16.6 events per 100,000 populations (Lui et al 2002). Another Chinese study reported the incidence of DVT and PE of 17.1 and 3.9 per 100,000 populations (Cheuk et al 2004). The incidence of DVT in all three studies is almost one tenth that reported from developed counties; yet the problem of DVT remains to be a

There is remarkable disparity in standards of the health care among developing countries, especially the percentage of the Grand National Product that is expended in health care. Also, when comparing developed to developing countries, some countries like Saudi Arabia, Egypt, Jordan and the UAE could take the lead: Egypt (5.8%), Saudi Arabia (4%), Pakistan (2.4%) and India (4.8%) have limited total expenditure on health, compared to the United States (15.2%), Switzerland (11.5%), France (10.1%) and Norway (10.3%) (WHO Health Report, 2006). Such disparity shows up as unequal distribution of healthcare personnel and deficiency in training programs in the developing world. This is also reflected

In reviewing the available evidence on the epidemiology of deep vein thrombosis (DVT) in the developing countries, it is quite clear that there are few on-going registries that track data on patients with DVT. Most of those registries are hospital-based rather than national. For example in Saudi Arabia there is the Saudi Thrombosis and Familial Thrombophilia (S-TAFT) Registry (Saour et al., 2009), which is considered the only registry in Gulf Region and

on the life expectancy and disease outcome and survival in these countries.

and Hispanics compared to Caucasians (Kearon 2001, White et al 2009).

thrombohphylaxis to avoid the risk of VTE.

health problem that clinicians should be aware of.

**3.2 Challengesof DVT In developing countries 3.2.1 Health disparity in the developing world** 

**3.2.2 Registries** 

clinical basis for these differences remain largely undefined (White et al ., 2009).

The burden of DVT in the developing world is unknown due to lack of documentation and large-scale research projects aiming at identifying the different epidemiology aspects. Some of the developing countries (Saudi Arabia, United Arab of Emirates and the rest of the Arab Gulf countries), have the financial resources to setup such registries. However, setting up registries requires substantial training to the current and future personnel who are working fulltime in maintaining them. Policymakers, represented by the governments, academic medical centers and, most importantly, local and regional funding agencies, must work together in order to consider emphasizing DVT as a public health problem so that the appropriate increasing proportion of public health resources is reallocated to address DVT and its related issues.

#### **3.2.4 The cost and value of pharmacoeconomics research**

Registries will not only allow tracking DVT in terms of its epidemiology, but also how much it burdens each country's economy. Pharmacoeconomic analysis is of great value in the evaluation of the cost of medical care. For example, cost-identification analysis seeks to identify the cost of providing the treatment of the disease. Cost-minimization analysis seeks to identify the least expensive alternative intervention to get the same outcome after treating the disease. Most importantly, cost-of-illness analysis estimates the total financial burden of DVT or its associated disability (e.g. reduced working hours, sick days, less life-expectancy etc…) to the country. This is done by estimating the total cost of diagnosing DVT, its management and the DVT-associated lost productivity. Cost-benefit analysis evaluates one or more treatment regimens in terms of pure currency expressions (e.g. dollars). This will allow the governments to identify which diseases cost higher. For example, in this form of analysis, we can compare the cost of DVT awareness, prevention and treatment to the cost of chronic kidney disease. Such analysis guides the policymakers to identify the top ranked diseases affecting the economy and allocates more dollars to combat them.

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