Figure 4.a-c.

Weighted and adjusted time-to-event plots¹ showing time to first major macrovascular disease symptom, diagnostic test, or treatment after a mandated high-deductible health plan switch, compared to contemporaneous control group members who remained in low-deductible plans.

Abbreviation: HDHP, high-deductible health plan; aHR, adjusted hazard ratio. Vertical blue line is centered at the index month when high-deductible health plan members were switched into high-deductible health plans. Major macrovascular disease symptoms included intermittent claudication, peripheral artery disease related ischemic pain, cellulitis, abscess of upper and lower limb, embolism/thrombosis, ulcer of lower limb, acute osteomyelitis, transient ischemic attack, angina, and acute and sub-acute forms of ischemic heart disease (Appendix Table 4). Major macrovascular disease diagnostic testing included magnetic resonance angiogram, angiography, intravascular ultrasound, ambulatory cardiac monitoring, brain and neck vessel angiography, brain imaging, echocardiogram, exercise tolerance tests, stress echocardiogram, cardiac catheterization angiogram, computed tomography of coronary vessels, cardiac MRI, and perfusion imaging (Appendix Table 4). Major macrovascular disease procedure-based treatments included angioplasty/stenting, endarterectomy, peripheral artery bypass, peripheral artery thrombectomy/embolectomy, endarterectomy/stenting, percutaneous coronary intervention/angioplasty, and coronary artery bypass grafting (Appendix Table 4).

¹Plots derived from parametric regression survival-time models with a Weibull distribution and adjusted for age group, gender, race/ethnicity, diabetes patients per employer category, and US region; and using weights derived from the coarsened exact matching algorithm.