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Mean Health Care Cost for PAD Exceeds CAD
By Bruce Jancin
ORLANDO— Peripheral artery disease is underdiagnosed and undertreated, possibly because in some quarters it is not considered as serious as other forms of atherosclerosis. Yet the mean patient costs for PAD are significantly higher than for coronary artery disease, according to a large study.
This cost-of-care difference is driven in part by the substantially greater health care costs for PAD in diabetic patients, Dr. Michael R. Jaff reported at the annual meeting of the American College of Cardiology.
However, the median cost of care for patients with CAD is higher than for PAD, implying the higher mean costs associated with PAD are due to more high-cost outliers, added Dr. Jaff of Massachusetts General Hospital, Boston.
He used the PharMetrics Patient-Centric Database to identify 3,301 patients who underwent revascularization for newly diagnosed PAD and 20,705 patients revascularized for CAD during January 2003-January 2008. The main purpose was to compare the two groups in terms of costs for revascularization and 1 year of follow-up care.
The mean total cost in the PAD group was $56,583, compared with $51,269 in the CAD group. In contrast, the median total cost in the PAD patients was $32,145 versus $38,927 in the CAD group.
Mean total costs for PAD and CAD in nondiabetic patients were closely similar: $47,764 versus $47,359. In type 1 diabetic patients, however, the mean 1-year cost was $107,766 for patients with PAD and $80,143 for those with CAD. In patients with type 2 diabetes, the mean cost was $65,734 for PAD patients and $56,782 for CAD patients, with median costs of $36,618 and $41,537, respectively, he continued.
Diagnosis of PAD in this commercially insured population increased at a greater rate during 2003-2007 than did CAD. The prevalence of PAD grew from 0.4% in 2003 to 0.6% in 2007, about 45% increase. The prevalence of CAD rose by 20%, from 1.4% to 1.7%.
Women comprised 40% of PAD patients but only 23% of CAD patients.
Cardiologists were the main providers of care for CAD. Care for PAD was much more widely distributed among various medical specialties. (See chart).
Dr. Jaff reported having no conflicts of interest with regard to this study.
When asked to comment on this story, Dr. Frank Pomposelli stated: “No vascular surgeon will be surprised by the findings in this study. I suspect that not only is the incidence of PAD rising but also physician awareness, which drives referrals for treatment. What is unclear is if the high cost of delivering care reflects the complexities of managing patients with multiple comorbidities or if it is something else. My own experience has been that there is wide variation in the way care is delivered to these patients by specialists from different disciplines and that those differences impact on costs.
“A study addressing this issue is being presented at the annual Vascular Meeting in Denver this year. The rapid acceptance and widespread application of endovascular therapies is especially relevant, especially the many newer technologies such as atherectomy, laser and cryoplasty, which are considerably more expensive than angioplasty, but not necessarily any more effective,” said Dr. Pomposelli, who is an associate professor of surgery at Harvard Medical School and clinical chief of the division of vascular surgery at the Beth Israel Deaconess Medical Center.
“Moreover, the ability to treat vascular disease less invasively has lowered the threshold for intervention (ex. the treatment of intermittent claudication) undoubtedly contributing to higher costs especially when multiple reinterventions are needed as is common in patients with diabetes,” he concluded.
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© 2010 VascularWeb. All rights reserved. Use of the VascularWeb site constitutes acceptance of all of the policies, rules and regulations for the site.