January 13, 2020

Insurance Data From Large Patient Cohort Used to Analyze Peripheral Arterial Occlusive Disease in Germany

January 13, 2020—Treatment and comorbidity patterns among patients with peripheral arterial occlusive disease (PAOD) were evaluated using up-to-date longitudinal patient-related data from health insurance claims in Germany. The study by Thea Kreutzburg et al was published as an Editor’s Choice article in the European Journal of Vascular and Endovascular Surgery (EJVES; 2020;59:59–66).

The retrospective study was composed of patients insured by Barmer Health Insurance, the second-largest health insurance provider in Germany. Comorbidities were categorized with Elixhauser groups using the World Health Organization International Classification of Diseases (10th Revision) codes and summarized as the linear van Walraven score (vWS). A trend analysis of the comorbidities was performed after standardization by age and sex.

As summarized in EJVES, the investigators reported that the study was composed of 156,217 patients who underwent 202,961 hospitalizations (49.4% for chronic limb-threatening ischemia in 2016) with PAOD during the study period.

Among the Barmer cohort from 2008 to 2016, the investigators observed the following:

  • Annual incidence of PAOD decreased (− 4.4%)
  • Prevalence of PAOD increased (+ 23.1%)
  • Number of hospitalizations increased (+ 25.1%)
  • Peripheral vascular interventions increased (+ 61.1%)
  • Disease-related reimbursement costs increased (+ 31%)
  • Major amputations decreased (− 15.1%)
  • Proportion of patients aged 71 to 80 years among overall PAOD patient population increased (+ 10%)
  • Mean vWS increased by two points

Additionally, considerable increases were found in the rates of hypertension, renal failure, and hypothyroidism, whereas the rates of diabetes and congestive heart failure decreased over time.

Increasing numbers of peripheral vascular interventions performed on these aging and sicker patients led to rising costs but correlated with decreasing major amputation rates, concluded the investigators in EJVES.


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