Resource use and costs in high-risk symptomatic peripheral artery disease patients with diabetes and prior acute coronary syndrome: a retrospective analysis

ABSTRACT

Objectives: 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.

KEYWORDS:

• Peripheral artery disease
• diabetes
• acute coronary syndrome
• myocardial infarction
• cost
• outcomes
• resource use

Acknowledgments

Medical writing and editorial assistance was provided by Leonard Lionnet, PhD. Manuscript review and editorial support were provided by Alan T. Hirsch, MD and Susan Duval, PhD from the University of Minnesota School of Medicine. This assistance was funded by Merck & Co., Inc., Kenilworth, NJ.

Financial & competing interests disclosure

This study was funded by Merck & Co., Inc., Kenilworth, NJ, USA. Writing assistance as described above was funded by Merck & Co., Inc. M Reed Chase and K Heithoff are employees of Merck & Co., Inc. HS Friedman and P Navaratnam are paid consultants for Merck & Co., Inc. RJ Simpson is a paid consultant for Merck, Pfizer, and Amgen, and has received speaker’s fees from Merck and Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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