Intermittent claudication treatment patterns in the commercially insured non-Medicare population.

Area of Science:

• Vascular Surgery
• Health Services Research
• Interventional Cardiology

Background:

• Published guidelines for intermittent claudication (IC) primarily focus on Medicare patients.
• Treatment patterns for younger, commercially insured IC patients and the impact of evolving endovascular interventions are not well-defined.

Purpose of the Study:

• To characterize IC treatment patterns in the commercially insured, non-Medicare population.
• To analyze temporal trends in IC interventions with the rise of endovascular techniques and outpatient centers.

Main Methods:

• Analysis of the IBM MarketScan Commercial Database (2007-2016) for newly diagnosed IC patients.
• Evaluation of patient demographics, medication use (statins), and intervention types (open vs. endovascular).
• Modeling of time trends using linear regression (R² assessment).

Main Results:

• Over 300,000 IC patients were identified; 14.3% received interventions, with a significant decrease in time from diagnosis to intervention (230 days in 2008 to 49 days in 2016).
• Ambulatory interventions increased, with a rise in atherectomy use (9.7% to 29%) particularly in office-based/surgical centers (57.6% atherectomy in 2016).
• Statin use at diagnosis was 48%, increasing to 52% after one year; inpatient atherectomy rates remained stable.

Conclusions:

• Intermittent claudication treatment has shifted towards shorter times to intervention for younger, commercially insured patients, often involving multiple procedures.
• Ambulatory settings, especially office-based centers, are increasingly adopting atherectomy for IC treatment.
• Low statin utilization highlights a potential area for improved medical management in this patient group.