Abstract
Objective/backgroundThere are few published data on the acute care or long-term costs after acute/critical limb or visceral ischaemia (ACLVI) events. Using data from patients with acute events in a population based incidence study (Oxford Vascular Study), the present study aimed to determine the long-term costs after an ACLVI event.MethodsAll patients with first ever incident ACLVI from 2002 to 2012 were included. Analysis was based on follow up until January 2017, with all patients having full 5 year follow up. Multivariate regressions were used to assess baseline and subsequent predictors of total 5 year hospital care costs. Overall costs after an ACLVI event were benchmarked against those after stroke in the same population, during the same period.ResultsAmong 351 patients with an ACLVI event, mean 5 year total care costs were €35,211 (SD 50,500), of which €6443 (18%) were due to long-term institutionalisation. Costs differed by type of event (acute visceral ischaemia €16,476; acute limb ischaemia €24,437; critical limb ischaemia €46,281; p < 0.001). Results of the multivariate analyses showed that patients with diabetes and those undergoing above knee amputations incurred additional costs of €11,804 (p = 0.014) and €25,692 (p < 0.001), respectively. Five year hospital care costs after an ACLVI event were significantly higher than after stroke (€28,768 vs. €22,623; p = 0.004), but similar after including long-term costs of institutionalisation (€35,211 vs. €35,391; p = 0.957).ConclusionLong-term care costs after an ACLVI event are considerable, especially after critical limb ischaemia. Hospital care costs were significantly higher than for stroke over the long term, and were similar after inclusion of costs of institutionalisation.
Highlights
Cardiovascular disease is the leading cause of death and disability, costing the US and European Union healthcare peripheral arterial disease (PAD) has a poor prognosis,3 it has been neglected in terms of research,4 and there are a paucity of data evaluating the economic impact of PAD on healthcare systems. a number of studies have been published assessing the care costs of PAD, these have tended to be based on hospital coding data of diagnosis or interventions;5e7 concentrated only on patients with diabetesRamon Luengo-Fernandez et al.or specific interventions,8,9 more stable PAD;10 or randomised controlled trials with stringent inclusion criteria;11 and have tended to omit long-term institutionalisation care costs
For all 351 patients with an acute/critical limb or visceral ischaemia (ACLVI) event, the mean 5 year total care costs after the event were V35,211, of which 18% (V6443) were due to longterm institutionalisation admission and 72% (V28,768) were hospital care costs (Table 1)
Most previous studies assessing the healthcare costs of PAD have been based on hospital coding data of diagnosis or interventions.5e7 these types of study aim to estimate the costs of PAD in a large population, allowing them to individually link patients’ medical records over time, they rely heavily on accurate coding to identify the index event
Summary
Specific interventions, more stable PAD; or randomised controlled trials with stringent inclusion criteria; and have tended to omit long-term institutionalisation care costs. This lack of economic evidence on PAD outcome limits comparisons of outcome and cost between this and other conditions, which in turn reduces the ability to make decisions about the relative funding requirements for service provision and research. Using data from patients with an acute/critical limb or visceral ischaemia (ACLVI) event in a population based incidence study (Oxford Vascular Study [OXVASC]) ascertained between 2002 and 2012, the present study aimed to reliably determine the absolute long-term costs and their baseline and subsequent predictors. Given that the costs of other vascular disease, in this case stroke, have been estimated in the same population and using the same methodology, there is a unique opportunity to benchmark the long-term costs of these acute events against stroke
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