title: Clinical and economic burden in patients with diagnosis of peripheral arterial disease in a claims database in Japan.
abstract: OBJECTIVE
  The effect of peripheral arterial disease (PAD) among young and middle-aged adults can be significant, but no previous study has examined the prognosis and the associated health care cost of the disease in this population. We evaluated the clinical and economic burden of PAD in patients from a large claims database to clarify the effect of the disease on a relatively young working Japanese population.
  
  
  METHODS
  Patients aged ≥45 and ≤64 years with first PAD diagnosis between 2005 and 2011 comprised the PAD cohort (n = 362); an age- and sex-matched non-PAD comparison cohort (n = 362) was also identified. Rates of cardiovascular events/interventions, health care utilization, and costs were compared.
  
  
  RESULTS
  The mean (SD) age of the cohort was 52.8 (5.6) years and 40.8% were women. Baseline Charlson comorbidity index was significantly higher in the PAD cohort than in the non-PAD cohort (1.90 [2.19] vs 1.16 [1.99]; P < 0.001). The PAD cohort had significantly higher first-year event rates than did the non-PAD cohort for myocardial infarction (2.2% vs 0.2%; P = 0.019) and ischemic stroke (4.1% vs 0.5%; P = 0.001). Health care utilization was significantly greater for the PAD cohort for all parameters assessed (number of hospitalization, inpatient days, and outpatient visits) in the first year (all, P < 0.001). Total annual costs for health care were significantly higher in the PAD cohort than in the non-PAD cohort in the first year (P < 0.001). Among patients with diabetes, patients with PAD (n = 98) had significantly greater first-year event rates (myocardial infarction, ischemic stroke, coronary artery bypass surgery, peripheral arterial revascularization, percutaneous coronary intervention, and limb amputation; all, P < 0.001), significantly greater number of clinic visits (P = 0.023), and total cost burden than did patients without PAD (n = 63).
  
  
  CONCLUSIONS
  Even in a relatively young working Japanese population, PAD is associated with substantial clinical and economic burden.
authors.affiliation: Department of Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan. Electronic address: hosaka-a@umin.ac.jp.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hosaka
authors.affiliation: Vascular Center, Sanno Hospital and Sanno Medical Center, Tokyo, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Miyata
authors.affiliation: Sanofi K.K., Japan, Tokyo, Japan.
authors.forename: Yoshie
authors.initials: Y
authors.lastname: Onishi
authors.affiliation: Sanofi, US LLC, Bridgewater, New Jersey.
authors.forename: Laura
authors.initials: L
authors.lastname: Liao
authors.affiliation: Sanofi, US LLC, Bridgewater, New Jersey.
authors.forename: Quanwu
authors.initials: Q
authors.lastname: Zhang
mesh_terms: D000067575:Administrative Claims, Healthcare; D016022:Case-Control Studies; D015897:Comorbidity; D017281:Cost of Illness; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D009819:Office Visits / Q000706:statistics & numerical data; D058729:Peripheral Arterial Disease / Q000191:economics* / Q000453:epidemiology* / Q000601:surgery; D011379:Prognosis; D020521:Stroke / Q000453:epidemiology*
keywords: Japan; clinical burden; economic burden; health care utilization; peripheral arterial disease