TY - JOUR
T1 - The Contribution of Tobacco Use to High Health Care Utilization and Medical Costs in Peripheral Artery Disease A State-Based Cohort Analysis
AU - Duval, Sue
AU - Long, Kirsten Hall
AU - Roy, Samit S
AU - Oldenburg, Niki C.
AU - Harr, Kelsey
AU - Fee, Rebecca M.
AU - Sharma, Ratnendra R.
AU - Alesci, Nina L.
AU - Hirsch, Alan T
N1 - Publisher Copyright:
© 2015 American College of Cardiology Foundation.
PY - 2015/10/6
Y1 - 2015/10/6
N2 - Background Tobacco use is an important preventable cause of peripheral artery disease (PAD) and a major determinant of adverse clinical outcomes. Objectives This study hypothesized that tobacco use by PAD patients would be associated with higher health care utilization and associated costs. Methods We 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 ≥1 PAD-related claim. 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. Results A PAD cohort of 22,203 was identified, comprising 1,995 (9.0%) 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 the PAD tobacco users were hospitalized, 35% higher than nonusers in the total cohort (p < 0.001) and 30% higher in the subgroup (p < 0.001). In both cohorts, users were more frequently admitted for peripheral or visceral atherosclerosis (p < 0.001), acute myocardial infarction (p < 0.001), and coronary heart disease (p < 0.05). 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, persisting after adjustment for age, sex, comorbidities, and insurance type. Conclusions Tobacco use in PAD is associated with substantial increases in PAD-related hospitalizations, coronary heart disease and PAD procedures, and significantly greater costs. The results suggest that immediate provision of tobacco cessation programs may be especially cost effective.
AB - Background Tobacco use is an important preventable cause of peripheral artery disease (PAD) and a major determinant of adverse clinical outcomes. Objectives This study hypothesized that tobacco use by PAD patients would be associated with higher health care utilization and associated costs. Methods We 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 ≥1 PAD-related claim. 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. Results A PAD cohort of 22,203 was identified, comprising 1,995 (9.0%) 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 the PAD tobacco users were hospitalized, 35% higher than nonusers in the total cohort (p < 0.001) and 30% higher in the subgroup (p < 0.001). In both cohorts, users were more frequently admitted for peripheral or visceral atherosclerosis (p < 0.001), acute myocardial infarction (p < 0.001), and coronary heart disease (p < 0.05). 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, persisting after adjustment for age, sex, comorbidities, and insurance type. Conclusions Tobacco use in PAD is associated with substantial increases in PAD-related hospitalizations, coronary heart disease and PAD procedures, and significantly greater costs. The results suggest that immediate provision of tobacco cessation programs may be especially cost effective.
KW - administrative data
KW - health economics
KW - peripheral artery disease
KW - smoking
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U2 - 10.1016/j.jacc.2015.06.1349
DO - 10.1016/j.jacc.2015.06.1349
M3 - Article
C2 - 26429081
AN - SCOPUS:84942568728
SN - 0735-1097
VL - 66
SP - 1566
EP - 1574
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 14
ER -
