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

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

J Am Coll Cardiol. 2015 Oct 6;66(14):1566-1574. doi: 10.1016/j.jacc.2015.06.1349.

Authors

Sue Duval¹, Kirsten Hall Long², Samit S Roy³, Niki C Oldenburg³, Kelsey Harr⁴, Rebecca M Fee⁵, Ratnendra R Sharma⁵, Nina L Alesci⁵, Alan T Hirsch³

Affiliations

¹ Vascular Medicine Program, Cardiovascular Division and Lillehei Heart Institute, University of Minnesota Medical School, Minneapolis, Minnesota. Electronic address: sueduval@umn.edu.
² K. Long Health Economics Consulting, St. Paul, Minnesota.
³ Vascular Medicine Program, Cardiovascular Division and Lillehei Heart Institute, University of Minnesota Medical School, Minneapolis, Minnesota.
⁴ Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota.
⁵ Health Economics, Blue Cross Blue Shield of Minnesota, Eagan, Minnesota.

PMID: 26429081
DOI: 10.1016/j.jacc.2015.06.1349

Abstract

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.

Keywords: administrative data; health economics; peripheral artery disease; smoking.

MeSH terms

Aged
Aged, 80 and over
Cross-Sectional Studies
Female
Health Care Costs / statistics & numerical data*
Hospitalization / economics
Hospitalization / statistics & numerical data*
Humans
Male
Middle Aged
Minnesota / epidemiology
Patient Acceptance of Health Care / statistics & numerical data*
Peripheral Arterial Disease / economics*
Peripheral Arterial Disease / epidemiology
Peripheral Arterial Disease / therapy
Retrospective Studies
Risk Factors
Tobacco Use / adverse effects
Tobacco Use / economics*
Tobacco Use / epidemiology