Abstract 19507: High Smoking-attributable Healthcare Utilization and Associated Costs in a Large Insured PAD Cohort
Background: Tobacco use is the most important preventable cause of peripheral artery disease (PAD). Yet no prior investigations have examined the smoking-attributable costs in patients with PAD. We hypothesized that PAD smokers have more healthcare encounters and higher costs than PAD non-smokers.
Methods: We conducted a retrospective, cross-sectional study using 2011 claims data from a health plan in Minnesota. The total cohort included individuals with 12 months of continuous enrollment in a medical plan with at least one PAD-related claim. PAD, comorbidities, and smoking were identified using ICD-9 and CPT codes. Smoking specificity was increased among a subsample with pharmacy claims adding NDC codes for tobacco cessation pharmacotherapies. The primary outcome was the mean cost difference between smokers and non-smokers. Multivariable generalized linear models accounted for potential confounding and 95% confidence intervals (95% CI) were estimated by bootstrap methods.
Results: In the total PAD cohort, 1,995/22,203 (9.0%) smokers were identified, with 1,158/9,027 (12.8%) smokers in the pharmacy subsample. There were 22,220 hospitalizations in the total cohort and 8,152 hospitalizations in the pharmacy subsample. Half of the PAD smokers in both samples were hospitalized; a rate 35% higher than non-smokers in the total cohort (p<0.001) and 30% higher in the subsample (p<0.001). In both cohorts, smokers were significantly more likely than non-smokers to be hospitalized for COPD (p<0.001), peripheral or visceral atherosclerosis (p<0.001), acute MI (p<0.001), and coronary heart disease (p<0.05). Observed costs were, on average, $18,123, higher for smokers vs. non-smokers (95% CI of difference: $13,125-$23,121). This difference persisted with adjustment for age, sex, comorbid conditions, insurance type, and Minnesota residence (adjusted cost difference of $17,673: 95% CI $13,225-$22,339).
Conclusion: Tobacco use in patients with PAD is associated with extreme differences in clinical events and associated costs. The substantial smoking-attributable economic burden suggests that tobacco cessation programs may be especially cost-effective for this population.
Author Disclosures: S.S. Roy: None. S. Duval: None. K.H. Long: None. N.C. Oldenburg: None. N.L. Alesci: None. R.M. Fee: None. R.R. Sharma: None. A.T. Hirsch: None.
- © 2014 by American Heart Association, Inc.