September 28, 2015
Statewide Study Evaluates Effect of Smoking on Costs for PAD Treatment
September 29, 2015—The American College of Cardiology (ACC) announced the publication of an analysis of medical costs associated with atherosclerotic lower extremity peripheral artery disease (PAD), which found that health care costs in 1 year were $18,000 higher in smokers versus nonsmokers with the condition. Within 1 year, 49% of tobacco users with PAD in the study were hospitalized, a hospitalization rate 35% higher than nonusers. The findings were published online ahead of print by Sue Duval, PhD, et al in the Journal of the American College of Cardiology (JACC; 2015;66:1566–1574).
According to the ACC, the investigators from the University of Minnesota Medical School in Minneapolis, Minnesota, analyzed claims data from 2011 for 22,203 individuals with PAD from the largest health plan in Minnesota. They found that smokers are more likely to be hospitalized for leg events, heart attack, and coronary heart disease related to PAD than nonsmokers with PAD.
Also in JACC, an accompanying editorial by Geoffrey D. Barnes, MD, and Elizabeth Jackson, MD, of the University of Michigan Health System, noted that the study highlights the urgent need for smoking cessation among PAD patients, and getting patients to quit can improve care and save significant health dollars over the long term (2015;66:1575–1576). The ACC noted that the study and editorial are part of a comprehensive Population Health Promotion issue of JACC focusing on issues that broadly impact public health and the prevention of cardiovascular disease and related conditions.
As summarized in JACC, the investigators 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 one or more PAD-related claims. 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.
The investigators identified a PAD cohort of 22,203 patients that included 1,995 (9%) 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 of tobacco users with PAD were hospitalized, which was 35% higher than nonusers in the total cohort and 30% higher in the subgroup. In both cohorts, users were more frequently admitted for peripheral or visceral atherosclerosis, acute myocardial infarction, and coronary heart disease. 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, even after adjustment for age, sex, comorbidities, and insurance type, reported the investigators in JACC.