Treating Peripheral Arterial Disease After Revascularization - Episode 4

Costs of Major Atherothrombotic Vascular Events in PAD After Revascularization

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Marc Bonaca, MD, MPH, elaborates on the costs associated with major atherothrombotic vascular events for patients with PAD after revascularization.

Manesh Patel, MD: Marc, I’ll ask you. You told us about the events our patients have. Sonia told us about some of the burdens. What’s the cost burden of our patients with PAD [peripheral arterial disease]? I think about the number of times they have to come into the clinic, but then if you have 1 revascularization, what the repeat rates might be, and the costs might be to the system. I’m assuming it’s a fairly significant cost burden, but I didn’t know if you had a way you think about that.

Marc P. Bonaca, MD, MPH: It’s a great question, Manesh, and there are a lot of analyses looking at burden of disease and how that reflects cost. Sometimes those things don’t align with what we would think clinically or as an individual. For example, something like death actually turns out to be relatively inexpensive, not that it’s not the most feared outcome. It turns out that there are other things that drive cost, like the need to come back to the hospital for repeat procedures, for people to have wounds who need to come back for intensive wound care and need home nursing. And those things become particularly relevant in peripheral artery disease because not only do those patients share the burden of heart attack and stroke that patients with prior MI [myocardial infarction] and stroke have, and of course those are very debilitating. But they also have these limb outcomes that lead to inability to perform activities of daily living, require nursing care, require repeat procedures.

It turns out when you look among these populations, obviously as we get older things cost more, prevalent disease costs more than primary prevention. But when you look at patients with PAD relative to others with atherosclerosis, like stroke patients, the level of cost is really driven by disability, recurrent symptoms, need for recurrent procedures, and things like amputation that require prostheses, training. You can imagine it’s not easy for anyone to lose a limb, but most of these are older patients who already have comorbidities. So when you look at cost burden, there’s a differential effect in PAD where there’s a much greater cost burden. Actually, if you layer on top of that comorbidities, and this goes back to one of your prior questions, those with PAD and diabetes, that there’s almost a 50% increase in cost just by having that comorbidity because of the synergistic effects of infection, osteomyelitis, and other things like that. This is a very costly disease state.

Manesh Patel, MD: Yes, it’s certainly a big cost to our patients and our system, and so I think it’s an important thing that we’re probably all not always aware of, but we understand what it does to our system.

This transcript has been edited for clarity.