National health care costs of peripheral arterial disease in the Medicare population

Abstract

Lower extremity peripheral arterial disease (PAD) is prevalent in the Medicare population and is associated with high rates of myocardial infarction, stroke, amputation, and death. Nevertheless, national health expenditures for PAD are not known. We hypothesized that PAD-related costs are high, increase with age, and that treatment rates would be less than known PAD prevalence. The objective was to determine national health care expenditures for PAD in the United States. PADrelated treatment costs were calculated in the elderly, non-disabled Medicare population. The cost analysis relied on the 5% control population for the linked SEERMedicare data and Medicare claims for the calendar year 2001, identifying PAD cases based on diagnosis and procedure codes. Costs were aggregated separately for inpatient and outpatient treatment and estimates adjusted to reflect the Medicare population. A total of $4.37 billion was spent on PAD-related treatment and 88% of expenditures were for inpatient care. Medicare program outlays totaled $3.87 billion, while enrollees (or their supplemental insurance) spent the remaining $500 million. In total, 6.8% of the elderly Medicare population received treatment for PAD. Treatment increased with age at rates of 4.5%, 7.5%, and 11.8% for individuals aged 65-74, 75-84, and >85 years, respectively. PAD-related costs accounted for approximately 13% of all Medicare Part A and B expenditures for the PAD-treated cohort, and 2.3% of total Medicare Part A and B expenditures. In conclusion, US national PAD-related costs are high, associated with inpatient care, and increase with age. PAD is treated at rates lower than the known PAD prevalence as only approximately one-third of the population with known PAD had detectable PAD-related health care costs in our analysis. The potential impact of earlier PAD detection and use of outpatient preventive strategies on total national PAD health care costs is unknown.

Associations of Glycemic Control With Cardiovascular Outcomes Among US Hemodialysis Patients With Diabetes Mellitus

“…PAD was defined using previously established diagnosis codes and diagnosis‐related groups (Table 1). 22 …”

Pulse pressure and michigan neuropathy screening instrument are independently associated with asymptomatic peripheral arterial disease among type 2 diabetes community residents: A community-based screening program in Taiwan

“…The health care costs may also be reduced, especially in considering the burdens of late PAD and the inexpensiveness of screening tool. [20] Several studies have found an association of high pulse pressure with large artery stiffness, [21] higher mortality (overall, cardiovascular and cerebrovascular diseases) [22][23][24][25] and higher risks of foot ulcers. [26] However, most of these studies have been targeted at the general diabetic population.…”

Characteristics and Long-Term Follow-Up of Participants with Peripheral Arterial Disease During ALLHAT

“…Reduction of major modifiable risk factors, including hypertension, is critical, but the optimal antihypertensive therapy, when considering multiple cardiovascular disease outcomes, remains undetermined. 6 ALLHAT data provide several lessons. First, once PAD, sufficiently advanced as to require hospitalization or revascularization, develops, it is associated with a high rate of subsequent cardiovascular disease morbidity and all-cause mortality regardless of the type of antihypertensive treatment, thus underscoring the need for cardiovascular disease prevention.…”