Cost and inpatient burden of peripheral artery disease: Findings from the National Inpatient Sample

Kohn, Christine G.; Alberts, Mark J.; Peacock, W. Frank; Bunz, Thomas J.; Coleman, Craig I.

doi:10.1016/j.atherosclerosis.2019.05.026

Cited by 44 publications

(33 citation statements)

References 9 publications

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“…Similarly, the results from this analysis highlight that improved clinical outcomes are associated with considerable cost savings in the treatment of PAD. Kohn et al [17] have recently examined the economic burden of hospitalisations for PAD in the USA and reported a median hospital length of stay of 5 days (interquartile range, 3-9) with a total hospital cost of US$15,775, equating to a total annual cost burden of US$6.3 billion. The study determined that hospitalisations due to PAD resulted in a considerable economic burden on the healthcare system, which could be alleviated via improvements in screening and use of effective primary treatment.…”

Section: Discussionmentioning

confidence: 99%

A Budget Impact Model for the use of Drug-Eluting Stents in Patients with Symptomatic Lower-Limb Peripheral Arterial Disease: An Australian Perspective

Altaf

Ariyaratne²,

Peacock³

et al. 2021

Cardiovasc Intervent Radiol

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Purpose Improvement in long-term outcomes through innovative, cost-effective medical technologies is a focus for endovascular procedures aimed at treating symptomatic lower-limb peripheral arterial disease (PAD). The advent of drug-eluting stents (DES) has improved symptomatic PAD treatment via a reduction in high rates of target lesion revascularisation (TLR). The present study aimed to compare the 5-year financial impact of treatment with Eluvia, a new paclitaxel-eluting stent, versus treatment with Zilver PTX, a drug-coated stent, among patients in Australia by developing a budget impact model (BIM). Methods A BIM was developed from an Australian public hospital payer perspective using Australian national cost weights (AUD), published literature, and public hospital audit data. Clinical outcomes, including clinically driven TLRs (CD-TLRs), adverse events, and length of stay, were based on the 2-year results of the IMPERIAL trial, which compared Eluvia DES to Zilver PTX. Results Assuming EVP eligibility rate of 80% and DES uses rate ranging from 10 to 28% (superficial femoral artery lesions only), the 5-year model forecasted a treatment population between 14,428 and 40,399 patients. The model estimated 1499–4198 fewer CD-TLRs and 16,515–46,243 fewer hospital days with Eluvia DES use. This translated to 5-year potential savings of $4.3–$12.1 million to the Australian public hospital payer attributable to reduced CD-TLRs for Eluvia DES and $33.1–$92.6 million to Australian public hospitals owing to reduced adverse events and hospital bed days. Conclusion Eluvia DES use as treatment for symptomatic lower-limb PAD could lead to potential savings for the Australian public healthcare system based on improved patient outcomes.

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Section: Discussionmentioning

confidence: 99%

A Budget Impact Model for the use of Drug-Eluting Stents in Patients with Symptomatic Lower-Limb Peripheral Arterial Disease: An Australian Perspective

Altaf

Ariyaratne²,

Peacock³

et al. 2021

Cardiovasc Intervent Radiol

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“…12,13 A recent nationwide population-based study demonstrated that hospitalizations due to PAD result in a substantial economic burden to the US healthcare system, with the total cost for PAD hospitalizations surpassing $6 billion per year. 14 Another study estimates that a total of $4.37 billion was spent on PAD-related treatment for Medicare patients in 2001 alone. 15 A 2014 analysis of vascular surgery financial trends in tertiary care settings found that peripheral occlusive disease cases generated the most revenue, cost, and margin in comparison to aortic and cerebrovascular cases combined.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Patient and Hospital Characteristics on Total Costs of Peripheral Bypass in New York State

Ilonzo

Goldberger

Hwang

et al. 2021

Vasc Endovascular Surg

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Introduction: With the aging U.S. population, peripheral vascular procedures will become increasingly common. The objective of this study is to characterize the factors associated with increased total costs after peripheral bypass surgery. Methods: Data for 34,819 patients undergoing peripheral bypass surgery in NY State were extracted using the Statewide Planning and Research Cooperative System (SPARCS) database for years 2009-2017. Patient demographics, All Patient Refined Diagnostic Related Groups (APR) severity score, mortality risk, hospital volume, and length of stay data were collected. Primary outcomes were total costs and length of stay. Data were analyzed using univariate and multivariate analysis. Results: 28.1% of peripheral bypass surgeries were performed in New York City. 7.9% of patients had extreme APR severity of illness whereas 32.0% had major APR severity of illness. 6.3% of patients had extreme risk of mortality and 1 in every 5 patients (20%) had major risk of mortality. 24.9% of patients were discharged to a facility. The mean length of stay (LOS) was 9.9 days. Patient LOS of 6-11 days was associated with +$2,791.76 total costs. Mean LOS of ≥ 12 days was associated with + $27,194.88 total costs. Multivariate analysis revealed risk factors associated with an admission listed in the fourth quartile of total costs (≥$36,694.44) for peripheral bypass surgery included NYC location (2.82, CI 2.62-3.04), emergency surgery (1.12, CI 1.03-1.22), extreme APR 2.08, 1.78-2.43, extreme risk of mortality (2.73, 2.34-3.19), emergency room visit (1.68, 1.57-1.81), discharge to a facility (1.27, CI 1.15-1.41), and LOS in the third or fourth quartile (11.09, 9.87-12.46). Conclusion: The cost of peripheral bypass surgery in New York State is influenced by a variety of factors including LOS, patient comorbidity and disease severity, an ER admission, and discharge to a facility.

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“…The high impairment of the patients and the high hospitalization rate of this disease (89.5/100,000 in USA) make an early PAD diagnosis crucial. 5 The severity of PAD is usually assessed using the Ankle Brachial Index (ABI) and the ultrasound Doppler technique, considered as the gold standard in current clinical practice. 6 An emerging third alternative may be represented by the non-contact photoplethysmography (PPG) imaging, which is worthy of further exploration because of its relative simplicity.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a non-contact Photo-Plethysmographic Imaging (iPPG) system for peripheral arterial disease assessment

Lai

Dicorato

Wild

et al. 2021

Medical Imaging 2021: Biomedical Applications in Molecular, Structural, and Functional Imaging

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The flow of blood, or perfusion, of the skin can be indicative for the local and also systemic health of an individual. Peripheral Artery Diseases (PAD) are caused by the occlusions of arteries in the peripheral locations of the circulatory system. The high impairment of the patients and the high hospitalization rate of this disease make early diagnosis crucial. The severity of PAD is usually assessed using the Ankle Brachial Index (ABI) and the Ultrasound Doppler technique, which are considered as the gold standard in current clinical practice. Non-contact Photoplethysmography (PPG) imaging is a recent emerging technology capable of monitoring skin perfusion. Using an off-the-shelf camera and a light source, is possible to remotely detect the dynamic changes in blood volume in the skin and derive a map correlated to the blood perfusion. The aim of this study is the evaluation of a PPG imaging system (iPPG) for the assessment of Peripheral Arterial Diseases. Reduced blood flow is simulated on 21 volunteers by increasing the pressure in a pressure cuff. For each volunteer, measurements with iPPG, ultrasound, Laser Speckle Contrast Analysis (LASCA) and ABI were acquired, both on the hand and foot. Our experiments show that iPPG can detect reduced perfusion levels, and correlates well with the other measurement systems, suggesting that iPPG imaging is a valuable alternative to the other gold standard technologies for monitoring PAD. The proposed iPPG has the potential of providing a real-time feedback to the surgeons after resolving vessel stenosis.

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Cost and inpatient burden of peripheral artery disease: Findings from the National Inpatient Sample

Cited by 44 publications

References 9 publications

A Budget Impact Model for the use of Drug-Eluting Stents in Patients with Symptomatic Lower-Limb Peripheral Arterial Disease: An Australian Perspective

A Budget Impact Model for the use of Drug-Eluting Stents in Patients with Symptomatic Lower-Limb Peripheral Arterial Disease: An Australian Perspective

The Effect of Patient and Hospital Characteristics on Total Costs of Peripheral Bypass in New York State

Evaluation of a non-contact Photo-Plethysmographic Imaging (iPPG) system for peripheral arterial disease assessment

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