title: Resource use and costs in high-risk symptomatic peripheral artery disease patients with diabetes and prior acute coronary syndrome: a retrospective analysis.
abstract: OBJECTIVE
  As the prevalence of peripheral artery disease (PAD) increases there is growing concern about the associated healthcare burden. This burden has not been well-characterized in high-risk patients with concurrent diabetes and/or acute coronary syndrome (ACS). The objective of this analysis was to assess comorbidities, medication use, outcomes, services and costs for 3 high-risk symptomatic PAD groups.
  
  
  METHODS
  This retrospective longitudinal analysis used the MarketScan Commercial Claims and Encounters Database (2005-2013). The 3 high-risk symptomatic PAD groups were (1) symptomatic PAD with/without diabetes, (2) symptomatic PAD with/without prior ACS, and (3) symptomatic PAD with/without diabetes and prior ACS. The study time frame was a period of 1-year before the earliest date of a symptomatic PAD record and 3 years post.
  
  
  RESULTS
  In all, 16,663 symptomatic PAD patients were identified across the three risk groups. Mean age ranged from 66.4-67.4 years; the majority (55.0%-63.3%) were men. At 3 years post index, patients with symptomatic PAD and a risk factor had significantly higher use of beta-blockers, ACE inhibitors and statins (P<0.0007), and higher rates of all-cause and symptomatic PAD-related medical services, diagnoses and procedures (P<0.05). Clopidogrel and statins were used by ≤ 41.2% and ≤ 66.7% of symptomatic PAD patients without risk, respectively, and ≤ 68.9% and ≤ 80.2% of patients with risks. All cause and symptomatic PAD-related treatment costs (P<0.0001) were higher for symptomatic PAD patients with risks versus patients without risks where annualized all-cause cost differences ranged from $7,482 to $13,504 and annualized PAD-related cost differences ranged from $605 to $1,997.
  
  
  CONCLUSIONS
  Symptomatic PAD patients with diabetes and/or prior ACS have significantly higher medical resource use and costs compared to symptomatic PAD patients without these risk factors. The utilization rate of secondary prevention therapies is suboptimal; therefore, greater effort must be made to increase utilization and optimize treatment to minimize the impact of symptomatic PAD.
authors.affiliation: a Merck & Co., Inc ., Kenilworth , NJ , USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Reed Chase
authors.affiliation: b DataMed Solutions, LLC , New York , NY , USA.
authors.forename: Howard S
authors.initials: HS
authors.lastname: Friedman
authors.affiliation: b DataMed Solutions, LLC , New York , NY , USA.
authors.forename: Prakash
authors.initials: P
authors.lastname: Navaratnam
authors.affiliation: a Merck & Co., Inc ., Kenilworth , NJ , USA.
authors.forename: Kim
authors.initials: K
authors.lastname: Heithoff
authors.affiliation: c University of North Carolina School of Medicine , Chapel Hill , NC , USA.
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Simpson
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000077144:Clopidogrel; D003365:Costs and Cost Analysis; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D012189:Retrospective Studies; D012307:Risk Factors; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014481:United States
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: Peripheral artery disease; acute coronary syndrome; cost; diabetes; myocardial infarction; outcomes; resource use