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High economic burden, rates of revascularization for patients with PAD
Mahoney E. Cardiovasc Qual Outcomes. 2010;doi:10.1161/CIRCOUTCOMES.109.930735.
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Data from the REACH registry has suggested high cost estimates for patients with peripheral arterial disease, as well as high rates of revascularization, particularly in patients 1 year or older before baseline.
“A previous report from REACH (Reduction of Atherothrombosis for Continued Health) estimated and compared vascular-related hospitalization costs in patients enrolled in the U.S. with symptomatic CAD, CVD and PAD at enrollment and found costs to be higher for patients with symptomatic PAD, largely because of the high rate of peripheral revascularization procedures,” the researchers wrote. “Results from the current analysis extend those previous results.”
The analysis included patients at risk for atherothrombosis caused by established arterial disease or the presence of at least three atherothrombotic risk factors. Symptomatic PAD was defined as current intermittent claudication with an ankle-brachial index (ABI) of less than 0.9 or a history of lower-limb revascularization or amputation, whereas asymptomatic PAD was defined as an ABI of less than 0.9 in the absence of symptoms.
Of the total patients (n=25,763) enrolled, 2,396 (9.3%) had symptomatic and 213 (0.8%) had asymptomatic PAD at baseline. At 2-year follow-up, researchers reported a per patient mean cumulative hospitalization cost of $7,445 for patients with asymptomatic PAD, $7,000 for individuals with a history of claudication, $10,430 for patients with lower-limb amputation and $11,693 for those with revascularization (P=.007). Rates of lower-limb revascularization were high in patients 1 year or older before baseline (RR=1.79; 95% CI, 1.51-2.13) and to a lesser extent in patients older than 1 year before baseline (RR=1.30; 95% CI, 1.13-1.49).
“Cost estimates provided by this study are potential inputs into health economic models aimed at examining the long-term cost implications and cost-effectiveness of different treatment options, including secondary CV risk prevention strategies,” the researchers concluded. “Prospective studies of the effectiveness and cost-effectiveness of secondary prevention strategies aimed specifically at reducing PAD-related events seem warranted because effective interventions may curb the otherwise impending clinical and economic burden of PAD in the aging U.S. population.”
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