Clinical outcomes and medical care costs among medicare beneficiaries receiving therapy for peripheral arterial disease.
BACKGROUND
Peripheral arterial disease (PAD) is a common disorder with multiple options for treatment, ranging from medical interventions, surgical revascularization, and endovascular therapy. Despite the explosive advances in endovascular therapy, cost-effective methods of care have not been well defined. We analyze therapeutic strategies, outcomes, and medical cost of treatment among Medicare patients with PAD.


RESULTS
Patients who underwent therapy for PAD were identified from a 5% random sample of Medicare beneficiaries from Medicare Standard Analytic Files for the period 1999-2005. Clinical outcomes (death, amputation, new clinical symptoms related to PAD) and direct medical costs were examined by chosen revascularization options (endovascular, surgical, and combinations). One-year PAD prevalence increased steadily from 8.2% in 1999 to 9.5% in 2005. The risk-adjusted time to first post-treatment clinical outcome was lowest in those treated with "percutaneous transluminal angioplasty (PTA) or atherectomy and stents" (HR, 0.829; 95% CI, 0.793-0.865; p < 0.001) and stents only (HR, 0.904; 95% CI, 0.848-0.963; p = 0.002) compared with PTA alone. The lowest per patient risk-adjusted costs during the quarter of the first observed treatment were associated with "PTA and stents" ($15,197), and stents only ($15,867). Risk-adjusted costs for surgical procedures (bypass and endarterectomy) were $27,021 during the same period. Diabetes was present in 61.7% of the PAD population and was associated with higher risks of clinical events and higher medical costs compared with PAD patients without diabetes.


CONCLUSIONS
The clinical and economic burden of PAD in the Medicare population is substantial, and the interventions used to treat PAD are associated with differences in clinical and economic outcomes. Prospective cost-effectiveness analyses should be included in future PAD therapy trials to inform payers and providers of the relative value of available treatment options.
Jaff
Michael R
MR
Massachusetts General Hospital Vascular Center, Boston, MA 02114, USA. mjaff@partners.org
Cahill
Kevin E
KE
Yu
Andrew P
AP
Birnbaum
Howard G
HG
Engelhart
Luella M
LM
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation; D003362:Cost-Benefit Analysis; D003920:Diabetes Mellitus / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007342:Insurance Benefits / Q000191:economics; D008297:Male; D006278:Medicare / Q000191:economics*; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D016491:Peripheral Vascular Diseases / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D015995:Prevalence; D016016:Proportional Hazards Models; D015607:Stents / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000191:economics*