OBJECTIVES: Evaluate patients with newly diagnosed peripheral artery disease (PAD) undergoing angioplasty or stent in a United States commercially insured population.
METHODS: Patients with a PAD diagnosis (ICD-9-CM codes 440.xx or 443.9x) from 01/01/2010 to 12/31/2011, were identified in the MarketScan Commercial and Medicare databases. Patients were required to have great than or equal to 1 year of continuous plan enrollment before the 1st observed PAD diagnosis. Patients were also required to have an endovascular procedure (i.e., stent or angioplasty) on or after the 1st observed PAD diagnosis (1st procedure defined the index date) and greater than or equal to 2 years of continuous enrollment post-index date. Study measures included clinical characteristics and costs. Measures were reported by type of procedure received on the index date. Generalized linear models (GLM) with a log-link and gamma distribution were estimated to adjust for the effect of demographic and clinical characteristics on costs.
RESULTS: In total, 7,452 patients met the study inclusion criteria (23.7% angioplasty only, 62.9% stent only, and 13.4% both). Approximately 23% of patients had another endovascularization procedure performed in the 2-years post-index date. In year-1 post-index date, unadjusted costs for patients with angioplasty only were over twice (mean (SD) $120,586 [$164,419]) those for patients with stent only ($50,516 [$60,623]). Costs decreased in year-2 post-index date, with costs approximately 3 times greater for patients with angioplasty only ($86,412 [$164,087]) versus stent only ($26,464 [$53,149]). GLM analyses found during the 2-year follow-up, mean (SD) costs were $206,015 ($101,163) for patients with angioplasty only and $76,834 ($24,097) for patients with stent only.
CONCLUSIONS: Patients with PAD undergoing endovascularization procedures have a high rate of repeat procedures in the 2 years after their initial procedure. Costs are substantial during the 2 years after the initial endovascularization procedure and are greater for patients receiving angioplasty only versus patients receiving stent only.
