Delayed or forgone medical care associated with increased resource utilization and health care expenditures among patients with peripheral artery disease in the United States.

Abstract

Background: PAD affects >12 million Americans and poses significant financial burdens on patients, but the relationship between delayed/forgone (D/F) care and resource use in this population is unknown. We sought to assess the relationship between D/F care, resource use, and health care expenditures among patients with PAD.

Methods: Adults with PAD in the US were identified in the Medical Expenditure Panel Survey for years 2007-2017. Unweighted counts of reasons for D/F care were tabulated. Proportions of patients with ≥1 emergency department (ED), ≥1 inpatient, ≥1 outpatient, and >5 office-based encounters were compared using Rao-Scott adjusted Chi-Squared tests. Annual per capita total, out-of-pocket (OOP), ED, inpatient, outpatient, office-based visit, and prescription medication expenditures were compared using two-part econometric models.

Results: The study cohort included 2,926,654 patients with PAD. Among the 264,172 (9%) of patients with PAD reporting D/F care, 41.2% of patients cited financial barriers as the primary reason for D/F care. There were greater proportions of patients with ≥1 ED visits (52% vs 31%, P<0.001), ≥1 outpatient hospital visits (56% vs 43%, P=0.004), and >5 office-based visits (81% vs 71%, P=0.04) among those reporting D/F care versus those who did not. Patients with D/F care had $7,742 (95% CI $3,170-$12,314, P=0.001) greater per capita total and $5,156 (95% CI $692-$9,619, P=0.02) greater per capita inpatient expenditures per year than patients without D/F care.

Conclusions: D/F care is associated with increased resource use and health care expenditures among patients with PAD. Further work is needed to elucidate the underlying causes of D/F care and mitigate financial burdens on PAD patients.