Tobacco’s Cost Impact for Peripheral Artery Disease Patients

Study Questions:

What is the health care utilization and cost associated with tobacco use by patients with peripheral arterial disease (PAD)?


Using claims data from the largest Minnesota health plan from 2011, patients with continual enrollment and ≥1 PAD-related claim were included. Tobacco use was identified both through diagnostic codes and within a subcohort of patients with pharmacy benefits by identifying tobacco cessation pharmacotherapy billing. Outcomes included total costs, annual proportion of members hospitalized, and primary discharge diagnoses.


A PAD cohort of 22,203 patients was identified, including 1,995 (9.0%) tobacco users. Within the subcohort of pharmacy benefit patients, 1,158/9,027 (12.8%) were tobacco users. Within 1 year, nearly half of the PAD tobacco users were hospitalized, 35% higher than among nonsmokers (p < 0.001). Tobacco 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) diagnoses than nonsmokers. Costs for tobacco users were higher for tobacco users ($64,041) as compared to nonsmokers ($45,918). This cost difference persisted after adjustment for age, sex, comorbidities, and insurance type.


The authors concluded that tobacco use in PAD patients is associated with substantial increases in PAD-related hospitalizations and significantly greater costs.


The authors use statewide claims data to quantify the impact smoking has on patients with PAD. They use both claims data and pharmacy benefit data to ensure accurate identification of current smokers. While the increased costs associated with current tobacco use is not surprising, the impact on hospitalizations is surprising. In fact, while the leading reason for hospitalization among tobacco users was atherosclerotic disease, nonsmokers had 7-9 other more common diagnoses. Efforts to encourage tobacco cessation, particularly for PAD patients, are greatly needed.

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