The Contribution of Tobacco Use to High Health Care Utilization and Medical Costs in Peripheral Artery Disease: A State-Based Cohort Analysis

Sue Duval,Kirsten Hall Long,Samit S Roy,Niki C Oldenburg,Kelsey Harr,Rebecca M Fee,Ratnendra R Sharma,Nina L Alesci,Alan T Hirsch

doi:10.1016/j.jacc.2015.06.1349

Sue Duval, Kirsten Hall Long + Show 7 more

Open Access

https://doi.org/10.1016/j.jacc.2015.06.1349

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Abstract

BackgroundTobacco use is an important preventable cause of peripheral artery disease (PAD) and a major determinant of adverse clinical outcomes. ObjectivesThis study hypothesized that tobacco use by PAD patients would be associated with higher health care utilization and associated costs. MethodsWe 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. ResultsA 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. ConclusionsTobacco 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.

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