The Economic Burden of Peripheral Artery Disease: The Cost of Losing Patients in Healthcare Settings and Strategies to Overcome the Economic Burden

Peripheral artery disease (PAD) affects an estimated 200 million people worldwide, with a prevalence that increases with age (Fowkes et al., 2013). PAD is associated with significant morbidity, mortality, and healthcare costs.

Direct Costs of PAD

The direct costs of PAD can be attributed to diagnosis, treatment, and management of the disease, including hospitalization, medications, surgeries, and follow-up care. In the United States, the annual direct costs of PAD have been estimated to range from $21 to $42 billion (Mahoney et al., 2008). This includes the costs associated with lower extremity revascularization, amputations, and endovascular procedures.

Indirect Costs of PAD

The indirect costs of PAD include the loss of productivity and reduced quality of life due to disability, as well as the impact on caregivers and families. It is estimated that the indirect costs of PAD range from $38 to $46 billion per year (Mahoney et al., 2008). This significant financial burden is not only borne by patients and their families but also affects employers, insurance companies, and society as a whole.

Economic Burden of Losing Vascular Patients

The loss of vascular patients in healthcare settings has several economic consequences, including the following: 

• Increased readmission rates: Patients with PAD who are not adequately managed may experience worsening symptoms and complications, leading to hospital readmissions. These readmissions are costly to the healthcare system, with one study estimating that the 30-day readmission rate for PAD patients was 17.6%, costing an average of $11,013 per readmission (Jones et al., 2017). 
• Loss of revenue for healthcare providers: Poorly managed vascular patients may seek care elsewhere or discontinue their treatment, leading to a loss of revenue for healthcare providers. Additionally, providers may be penalized for suboptimal patient outcomes, further impacting their financial stability. 
• Increased costs for payers: The loss of vascular patients in healthcare settings results in a greater burden on insurance companies and other payers, as they must cover the costs of readmissions, additional treatments, and long-term disability.

Strategies to Reduce the Economic Burden of PAD

There are several strategies that can be employed to reduce the economic burden of PAD and prevent the loss of vascular patients in healthcare settings: 

• Early detection and intervention: Screening and diagnosis of PAD at an early stage can lead to more effective and less costly treatments (Criqui & Aboyans, 2015). Healthcare providers should implement evidence-based guidelines for screening and risk assessment to identify at-risk patients. 
• Comprehensive care: Providing comprehensive care for patients with PAD, including risk factor modification, medication management, and revascularization when appropriate, can improve patient outcomes and reduce the likelihood of complications and readmissions (Hirsch et al., 2006). 
• Patient education and self-management: Empowering patients with PAD to manage their condition through education and self-management strategies can lead to better adherence to treatment and improved outcomes (McDermott et al., 2014). 
• Care coordination: Coordinating care among different healthcare providers and settings can help ensure that patients receive consistent, high-quality care that addresses all aspects of their condition.

Peripheral artery disease imposes a significant economic burden on healthcare systems, patients, and society. Reducing this burden requires early detection, comprehensive care, patient education, and care coordination. By implementing these strategies, healthcare providers can improve patient outcomes, reduce the likelihood of complications and readmissions, and mitigate the financial impact of PAD on healthcare systems and patients.

References

Criqui, M. H., & Aboyans, V. (2015). Epidemiology of peripheral artery disease. Circulation Research, 116(9), 1509-1526.

Fowkes, F. G. R., Rudan, D., Rudan, I., Aboyans, V., Denenberg, J. O., McDermott, M. M., … & Criqui, M. H. (2013). Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. The Lancet, 382(9901), 1329-1340.

Hirsch, A. T., Haskal, Z. J., Hertzer, N. R., Bakal, C. W., Creager, M. A., Halperin, J. L., … & White, C. J. (2006). ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease). Journal of the American College of Cardiology, 47(6), e1-e192.

Jones, W. S., Patel, M. R., Dai, D., Subherwal, S., Stafford, J., Calhoun, S., & Peterson, E. D. (2017). High mortality risks after major lower extremity amputation in Medicare patients with peripheral artery disease. American Heart Journal, 183, 9-17.

Mahoney, E. M., Wang, K., Cohen, D. J., Hirsch, A. T., Alberts, M. J., Eagle, K., & Steg, P. G. (2008). One-year costs in patients with a history of or at risk for atherothrombosis in the United States. Circulation: Cardiovascular Quality and Outcomes, 1(1), 38-45.

McDermott, M. M., Domanchuk, K., Liu, K., Guralnik, J. M., Tian, L., Criqui, M. H., & Kibbe, M. R. (2014). The Group Oriented Arterial Leg Study (GOALS) to improve walking performance in patients with peripheral arterial disease. Contemporary Clinical Trials, 38(2), 350-358.