title: The Contribution of Tobacco Use to High Health Care Utilization and Medical Costs in Peripheral Artery Disease: A State-Based Cohort Analysis.
abstract: BACKGROUND
  Tobacco use is an important preventable cause of peripheral artery disease (PAD) and a major determinant of adverse clinical outcomes.
  
  
  OBJECTIVE
  This study hypothesized that tobacco use by PAD patients would be associated with higher health care utilization and associated costs.
  
  
  METHODS
  We conducted a retrospective, cross-sectional study using 2011 claims data from the largest Minnesota health plan. The total cohort included individuals with 12 months of continuous enrollment and ≥ 1 PAD-related claim. Tobacco cessation pharmacotherapy billing codes were queried in a subgroup with pharmacy benefits. Outcomes were total costs, annual proportion of members hospitalized, and primary discharge diagnoses.
  
  
  RESULTS
  A PAD cohort of 22,203 was identified, comprising 1,995 (9.0%) tobacco users. A subgroup of 9,027 with pharmacy benefits included 1,158 (12.8%) tobacco users. The total cohort experienced 22,220 admissions. The pharmacy benefits subgroup experienced 8,152 admissions. Within 1 year, nearly one-half the PAD tobacco users were hospitalized, 35% higher than nonusers in the total cohort (p < 0.001) and 30% higher in the subgroup (p < 0.001). In both cohorts, users were more frequently admitted for peripheral or visceral atherosclerosis (p < 0.001), acute myocardial infarction (p < 0.001), and coronary heart disease (p < 0.05). Observed costs in the total cohort were $64,041 for tobacco users versus $45,918 for nonusers. Costs for tobacco users also were consistently higher for professional and facility-based care, persisting after adjustment for age, sex, comorbidities, and insurance type.
  
  
  CONCLUSIONS
  Tobacco use in PAD is associated with substantial increases in PAD-related hospitalizations, coronary heart disease and PAD procedures, and significantly greater costs. The results suggest that immediate provision of tobacco cessation programs may be especially cost effective.
authors.affiliation: Vascular Medicine Program, Cardiovascular Division and Lillehei Heart Institute, University of Minnesota Medical School, Minneapolis, Minnesota. Electronic address: sueduval@umn.edu.
authors.forename: Sue
authors.initials: S
authors.lastname: Duval
authors.affiliation: K. Long Health Economics Consulting, St. Paul, Minnesota.
authors.forename: Kirsten Hall
authors.initials: KH
authors.lastname: Long
authors.affiliation: Vascular Medicine Program, Cardiovascular Division and Lillehei Heart Institute, University of Minnesota Medical School, Minneapolis, Minnesota.
authors.forename: Samit S
authors.initials: SS
authors.lastname: Roy
authors.affiliation: Vascular Medicine Program, Cardiovascular Division and Lillehei Heart Institute, University of Minnesota Medical School, Minneapolis, Minnesota.
authors.forename: Niki C
authors.initials: NC
authors.lastname: Oldenburg
authors.affiliation: Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota.
authors.forename: Kelsey
authors.initials: K
authors.lastname: Harr
authors.affiliation: Health Economics, Blue Cross Blue Shield of Minnesota, Eagan, Minnesota.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Fee
authors.affiliation: Health Economics, Blue Cross Blue Shield of Minnesota, Eagan, Minnesota.
authors.forename: Ratnendra R
authors.initials: RR
authors.lastname: Sharma
authors.affiliation: Health Economics, Blue Cross Blue Shield of Minnesota, Eagan, Minnesota.
authors.forename: Nina L
authors.initials: NL
authors.lastname: Alesci
authors.affiliation: Vascular Medicine Program, Cardiovascular Division and Lillehei Heart Institute, University of Minnesota Medical School, Minneapolis, Minnesota.
authors.forename: Alan T
authors.initials: AT
authors.lastname: Hirsch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D058729:Peripheral Arterial Disease / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D064424:Tobacco Use / Q000009:adverse effects / Q000191:economics* / Q000453:epidemiology
keywords: administrative data; health economics; peripheral artery disease; smoking