The Contribution of Tobacco Use to High Health Care Utilization and Medical Costs in Peripheral Artery Disease

• Published in: Journal of the American College of Cardiology 2015-10, Vol.66 (14), p.1566-1574
• Main Authors: Duval, Sue, PhD, Long, Kirsten Hall, PhD, Roy, Samit S., MSPH, Oldenburg, Niki C., DrPH, Harr, Kelsey, MPH, Fee, Rebecca M., MPH, Sharma, Ratnendra R., BA, Alesci, Nina L., PhD, MPH, Hirsch, Alan T., MD
• Format: Article
• Language: English
• Subjects: administrative data; Amputation; Cancer; Cardiology; Cardiovascular; Confidence intervals; Diabetes; Disease; Health care expenditures; health economics; Hospitalization; Hospitals; Hypertension; Internal Medicine; Medicare; Pain; Patients; peripheral artery disease; Pharmacy; Population; Smoking; Stroke; Tobacco
• ISSN: 0735-1097; 1558-3597
• 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.