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

Peripheral artery disease (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. Adults with PAD in the United States were identified in the Medical Expenditure Panel Survey for years 2007 to 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 χ² tests. Annual per capita total, out-of-pocket, ED, inpatient, outpatient, office-based visits, and prescription medication expenditures were compared using two-part econometric models. The study cohort included 2,926,654 patients with PAD. Among the 264,172 patients with PAD (9%) 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 < .001), ≥1 outpatient hospital visits (56% vs 43%; P = .004), and >5 office-based visits (81% vs 71%; P = .04) among those reporting D/F care vs those who did not. Patients with D/F care had $7742 (95% confidence interval, $3170-$12,314; P = .001) greater per capita total and $5156 (95% confidence interval, $692-$9,619; P = .02) greater per capita inpatient expenditures per year than patients without D/F care. 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 patients with PAD.