According to research conducted by THE SAGE GROUP, in 2010 approximately 17.6 million Americans suffered from PAD accounting for $164-$290 billion in health care spending.
“PAD-specific treatments are only one factor driving up spending,” stated Mary L. Yost, President. “Cardiovascular events, such as heart attacks and strokes, and related treatments account for over 40% costs adding significantly to the economic burden.”
“Other ‘hidden costs’ increase the total, so that the real economic burden of PAD is actually even higher,” Yost elaborated. “Two of these hidden costs, diabetic foot ulcers (DFU) and functional decline, have not typically been considered contributors to the total cost of PAD,” she continued.
“For example, diabetic foot ulcer patients with PAD are significantly more expensive to treat,” Ms. Yost explained. “According to our estimates, DFU treatment costs in PAD patients are 4.5 times greater and we believe that some, or even all of this cost difference, should be added to economic burden of PAD,” she declared. “A similar argument can be made for the costs associated with functional decline, impaired mobility and inability to work or perform the daily tasks of living.”
PAD, also known as peripheral vascular disease (PVD) is characterized by a reduction of blood flow to the lower limbs due to atherosclerosis. The most commonly recognized symptom is intermittent claudication (IC) or pain in the leg when walking which disappears at rest.
In the severe stages of PAD (critical limb ischemia or CLI) blood flow is so inadequate that ulcerations and gangrene occur. Once PAD has progressed to CLI, the risks of limb loss and mortality increase.
“As the nation grapples with a spiraling healthcare bill, it is important to keep in mind that early diagnosis is a key factor in reducing the costs of chronic diseases, such as PAD,” Ms. Yost observed.
PAD can be diagnosed by a simple, noninvasive test. This inexpensive test, known as the ankle-brachial index (ABI), is a cost-effective method to detect disease in asymptomatic patients. Although Medicare currently offers testing for patients with symptoms, PAD is most commonly asymptomatic. According to THE SAGE GROUP, 75% or 13.2 million U.S. citizens have asymptomatic PAD.
“Asymptomatic does not mean that the disease is benign. PAD is not just a leg problem; it is also a heart and a brain problem,” declared Ms. Yost. “Asymptomatic patients are hospitalized at similar rates and costs as those with IC, but not for leg treatments. The cause is heart attacks, strokes and other cardiovascular events.”
If diagnosed in the early stages, PAD patients can be treated with appropriate lifestyle modifications and drug therapies to reduce the risks of heart attack and stroke; exercise therapy to reduce the pain of claudication; or if blockages are more severe, with minimally invasive revascularization technologies.
“However, if the disease is not diagnosed until critical ischemia occurs, interventional therapy is more costly. If gangrene is so severe that the limb cannot be salvaged, the patient must undergo amputation, the most costly procedure,” Yost elaborated.
“Amputation is not only extremely undesirable from the patient’s viewpoint it is socially undesirable in terms of costs. The inability of a large percentage of these amputees to live independently adds significantly to the total cost burden,” she continued.
“Since the ABI test is generally not performed on asymptomatic PAD patients, significant numbers remain undiagnosed until they suffer a heart attack or develop ulcers and gangrene. In our opinion, this needlessly increases overall costs,” Ms. Yost observed.