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

• Published in: Journal of the American College of Cardiology 2015-10, Vol.66 (14), p.1566-1574
• Main Authors: Duval, Sue, Long, Kirsten Hall, Roy, Samit S, Oldenburg, Niki C, Harr, Kelsey, Fee, Rebecca M, Sharma, Ratnendra R, Alesci, Nina L, Hirsch, Alan T
• Format: Article
• Language: English
• Subjects: 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
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2015.06.1349

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