Document Detail

Clinical outcomes and medical care costs among medicare beneficiaries receiving therapy for peripheral arterial disease.
MedLine Citation:
PMID:  20579582     Owner:  NLM     Status:  MEDLINE    
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. METHODS AND 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. CONCLUSION: 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.
Michael R Jaff; Kevin E Cahill; Andrew P Yu; Howard G Birnbaum; Luella M Engelhart
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of vascular surgery     Volume:  24     ISSN:  1615-5947     ISO Abbreviation:  Ann Vasc Surg     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-06-28     Completed Date:  2010-10-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8703941     Medline TA:  Ann Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  577-87     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.
Massachusetts General Hospital Vascular Center, Boston, MA 02114, USA.
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MeSH Terms
Aged, 80 and over
Angioplasty, Balloon / adverse effects,  economics*,  instrumentation
Cost-Benefit Analysis
Diabetes Mellitus / economics,  epidemiology,  therapy
Health Care Costs*
Insurance Benefits / economics
Medicare / economics*
Outcome and Process Assessment (Health Care) / economics*
Peripheral Vascular Diseases / economics*,  epidemiology,  therapy*
Proportional Hazards Models
Stents / economics
Time Factors
Treatment Outcome
United States / epidemiology
Vascular Surgical Procedures / adverse effects,  economics*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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