The Sage Group

In Recognition of National Peripheral Artery Disease (PAD) Awareness Month, THE SAGE GROUP Comments on the Costs and Consequences of the Disease

ATLANTA, Sept 5, 2013 (BUSINESS WIRE)—According to THE SAGE GROUP LLC, peripheral artery disease afflicts almost 18 million Americans costing the U.S. between $164 and $290 billion annually.

“A decade ago we wrote that PAD was underestimated, underdiagnosed and undertreated,” stated Mary L. Yost, President of THE SAGE GROUP. “Unfortunately, this statement is still true.”

“Progress in increasing disease awareness among the public and the gatekeeper physicians has been slower than we anticipated,” explained Yost. “The result is continued underdiagnosis and undertreatment causing unnecessary mortality and morbidity.”

“As the nation grapples with a spiraling healthcare bill, it is important to keep in mind that early diagnosis is a key factor in reducing the costs of chronic diseases, such as PAD,” Ms. Yost observed.

PAD can be diagnosed by a simple, noninvasive test. This inexpensive test, known as the ankle-brachial index (ABI), is a cost-effective method to detect disease in asymptomatic patients. Although Medicare currently offers testing for patients with symptoms, PAD is most commonly asymptomatic. According to THE SAGE GROUP, 75% is asymptomatic.

“Asymptomatic does not mean the disease is benign. PAD is not just a leg problem; it is also a heart and a brain problem,” declared Ms. Yost. “Asymptomatic patients are hospitalized at similar rates and costs as symptomatic patients, not for leg treatments but for heart attacks and strokes.”

If diagnosed in the early stages, PAD patients can be treated with appropriate lifestyle modifications and drug therapies to reduce the risks of heart attack and stroke; exercise therapy to reduce the pain of claudication; or if blockages are more severe, with minimally invasive revascularization technologies.

“However, if the disease is not diagnosed until critical ischemia occurs, interventional therapy is more costly. If gangrene is so severe that the limb cannot be salvaged, the patient must undergo amputation, the most costly procedure,” Yost elaborated.

“Amputation is not only extremely undesirable from the patient’s viewpoint it is socially undesirable in terms of costs. According to our estimates, PAD amputations cost $10.6 billion,” she continued.

PAD, also known as peripheral vascular disease (PVD), is characterized by a reduction of blood flow to the lower limbs due to atherosclerosis. The most commonly recognized symptom is intermittent claudication (IC) or pain in the leg when walking, which disappears at rest.

In the most severe stages of PAD (critical limb ischemia or CLI) blood flow is so inadequate that ulcerations and gangrene occur. Once PAD has progressed to CLI, the risks of limb loss and mortality increase.

Describing the current treatment of CLI, Yost observed, “A paradox exists. Although major amputations have declined, primary amputation is frequently the first, and the only treatment offered. Recent research has shown that 60%-70% of CLI patients who undergo major amputation have no attempt at revascularization prior to amputation. Amazingly, this situation has remained unchanged for over 30 years!”

For Patients

Additional information about PAD and amputation prevention can be found at three nonprofit sites: the Save A Leg Save A Life Foundation at,
My Leg My Choice at and the Vascular Disease Foundation

THE SAGE GROUP, a research and consulting company, specializes in atherosclerotic disease in the lower limbs, specifically PAD, IC, CLI, Acute Limb Ischemia and ischemic diabetic foot ulcers. The most recent research focuses on quantifying the economic and social costs of PAD and CLI-related amputations.

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