The impact of economic recession on the use of treatment technology for peripheral arterial disease

•Using stents is a promising treatment option for femoropopliteal PAD lesions.•We found an association of economic change with femoropopliteal stent use.•We observed no association of femoropopliteal stent use with stent prices, reimbursement and relevant publications.•Results suggest a role of practice related variables at center and individual physician level.

ObjectivesThere is broad concern that economic recessions may have adversely affected both population health and healthcare. This study investigates whether economic changes may have affected the treatment of one of the major diseases in Germany, peripheral arterial disease (PAD), using femoropopliteal stent angioplasty.MethodsThis retrospective longitudinal study uses multivariate linear regression to examine associations between changes of five principal economic indicators between 2000 and 2010 and the demand for femoropopliteal stents in Germany between 2005 and 2010, controlling for the prevalence of PAD risk factors, cardiovascular drug demand, reimbursement of healthcare providers for stent implantation, stent selling prices of manufacturers and evidence from clinical studies.ResultsUnemployment in the population aged 25–74 years and the harmonized index of consumer price indices were associated with femoropopliteal stent demand in Germany with a time lag of 2.5 and 3 years, respectively.ConclusionsThere was an association between economic change and femoropopliteal stent demand. Results suggest a role of practice related variables at a center and individual physician level. More research is needed at this center and individual level to examine changes in decision making in PAD treatment following economic change.