Circ: Attempts to repair lower extremity PAD may fuel costs

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Even after attempts to repair blockages in peripheral artery disease (PAD) patients, hospitalizations and revascularizations still occur at high rates, leaving the healthcare system with a large economic burden, according to a study published online Oct. 12 in Circulation: Cardiovascular Quality and Outcomes.

PAD affects eight million Americans and is associated with a heightened risk of cardiovascular (CV) events. “Invasive treatment for PAD is costly, and a first invasive procedure becomes a risk factor for further procedures," the authors wrote.

It was estimated in previous research that the costs associated with vascular-related hospitalizations for PAD patients were almost $21 billion. Additionally, the risk of PAD increases 5 percent at age 50, 10 percent by age 65 and 25 percent in patients 80 and older.

Elizabeth Mahoney, ScD, of Saint Luke’s Mid America Heart and Vascular Institute in Kansas City, Mo., and colleagues evaluated 2,386 symptomatic PAD patients and 213 asymptomatic PAD patients from the REACH (Reduction of atherothrombosis for Continued Health) registry, to compare vascular-related hospitalization rates and their associated costs in PAD patient subgroups.

An ankle-brachial index (ABI) of less than 0.90 and the absence of symptoms identified PAD patients as asymptomatic. Patients were identified as symptomatic if they had current intermittent claudication with an ABI of less than 0.90 or a history of lower limb revascularization or amputation.

The patients had a mean age of 71, and 39 percent were women. Additionally, 51 percent of patients had diabetes, 88 percent had hypertension and 80 percent had hypercholesterolemia. Twenty percent of patients were current smokers and 53 percent were prior smokers.

The researchers found that 23 percent of the asymptomatic patients and 31 percent of the symptomatic patients had at least one vascular-related hospitalization during the two-year study period. Rates of vascular-related hospitalizations for symptomatic patients with claudication, prior revascularization and prior amputation were 25 percent, 32 percent and 36 percent, respectively.

Additionally, the researchers said that the overall two-year hospitalization costs per patient were $7,000 for patients with a history of claudication and $7,445 for those with asymptomatic PAD.

Additionally, for patients with lower limb amputation, the associated hospitalization costs were $10,430, and $11,693 for those with a history of revascularization procedures.

Patients who had a previous incidence of lower limb revascularization or amputation had increased rates of subsequent procedures at one to two years.

“[O]ur data suggest that even patients with asymptomatic PAD create a significant health economic burden because of the high cardiovascular event rate and other cardiovascular-related hospitalizations,” the researchers wrote. “Moreover, our data demonstrate that when lower-extremity procedures are performed, substantial recurrent hospitalizations are common, with repeated revascularization procedures and associated costs.”

The authors said that patients and physicians must understand that a first admissions to repair lower extremity PAD may not be a “cure.”

“Although these data demonstrate the very high cost of PAD, we note that there are no data now available that clarify whether more effective use of preventive interventions (i.e., more consistent use of risk reduction medications, access to supervised exercise programs, and smoking cessation strategies in this population) would reduce disease progression and costs associated with downstream vascular resource use; however, the potential seems likely,” the authors wrote.

If atherosclerosis in the lower extremities could be prevented so that fewer patients required peripheral revascularization procedures, costs to the healthcare system may decrease; however, Mahoney and colleagues urged that further studies that assess the effectiveness of care improvement initiatives associated with PAD are needed.

Sanofi-Aventis and Bristol-Myers Squibb funded the study.