A newly published US Medicare cohort study illuminates trends and factors associated with peripheral vascular interventions (PVIs)—including a sharp rise in the use of ambulatory surgical centres (ASCs) and office-based laboratories (OBLs) for treatment—from 2011 to 2022.
In the Journal of the American Heart Association (JAHA), first author Chen Dun, senior author Caitlin Hicks (both Johns Hopkins University School of Medicine, Baltimore, USA) and colleagues write that while previous cross-sectional studies have identified wide practice pattern variations in the use of PVI for the treatment of claudication, there is a paucity of data on longitudinal practice patterns. Against this backdrop, the investigators set out to describe the temporal trends and charges associated with PVI use for claudication over the past 12 years in the USA.
Dun et al conducted a retrospective analysis using 100% Medicare feefor- service claims data to identify all patients who underwent a PVI for claudication between January 2011 and December 2022. The researchers evaluated trends in utilisation and Medicare-allowed charges of PVI according to anatomic level, procedure type, and intervention settings using generalised linear models. They used multinomial logistic regressions to evaluate factors associated with different levels and types of PVI.
Overall, Dun and colleagues identified 599,197 PVIs performed for claudication. They report in JAHA that the proportional use of tibial PVI increased 1% per year and atherectomy increased by 1.6% per year over the study period.
Furthermore, they highlight that the proportion of PVIs performed in ASCs and OBLs grew at 4% per year from 12.4% in 2011 to 55.7% in 2022, and that total Medicare-allowed charges increased by US$11,980,035 per year.
Finally, the authors share that multinomial logistic regression identified “significant” associations between race and ethnicity and treatment setting with use of both atherectomy and tibial PVI.
In the conclusion of their findings, Dun et al summarise that the use of tibial PVI and atherectomy for the treatment of claudication has increased “dramatically” in the past decade “despite poor evidence supporting their efficacy, especially long term”. They stress that this trend is most notable in ASC and OBL settings and among non-white patients and has been associated with a “significant” increase in healthcare expenditures over time.
Dun and colleagues note that—to the best of their knowledge—this study is the most up-to-date analysis describing the use of PVI for claudication using longitudinal, nationally representative data.
The authors also acknowledge “several” limitations to their research, including the fact that their results are based on Medicare beneficiaries primarily aged 65 years and older who “might not be representative of the overall US population with claudication”. In addition, they recognise the downsides of administrative data, underscoring a possibility that patients they identified as having claudication had more advanced peripheral arterial disease and were misclassified. They also highlight the possibility that some of the trends they report “are related to an ageing population with an increased prevalence of risk factors, rather than practice-specific changes alone”.
Despite these limitations, Dun et al write as a closing statement that their results highlight “a critical need to improve the delivery of equitable, evidence-based and value-based care for the treatment of claudication”.
