Kim, C.M.

Lee, S.M.

Lim, S.J.

Suh, D.C.

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A202 V A L U E  I N  H E A L T H  1 6  ( 2 0 1 3 )  A 1 - A 2 9 8  
  
 
decisions, with the aim of improving inpatient outcomes among women with 
vulvar cancer.  
 
PHS93  
PATTERNS OF CARE, COSTS AND OUTCOMES OF CHEST PAIN PATIENTS 
WITHIN TWO YEARS OF INITIAL VISITS TO THE ER  
Abbass IM1, Virani SS2, Parikh R1, Taychakhoonavudh S1, Ganduglia C1, Franzini L1 
1The University of Texas School of Public Health, Houston, TX, USA, 2Baylor College of Medicine, 
Houston, TX, USA  
OBJECTIVES: To describe the pattern of care, costs, and outcomes of chest pain 
patients at two years after an initial ER visit using large longitudinal claim 
database. METHODS: This was a retrospective cross-sectional study using 
BlueCross BlueShield of Texas claims data of patients with unspecific chest pain 
(from 2008 to 2011). Only patients who have had three years of continuous 
enrollment with six months prior to their initial visits to the ER and at least two 
years of follow-up after the ER visit were included. Patients were categorized into 
four groups; group1 included patients who were sent home after their ER visit, 
group2 included patients who were admitted into observation units, group3 
included patients who were admitted into inpatient care and group4 included 
patients who were transferred into observation units and then inpatient care. 
The measured outcomes included myocardial infarction (MI), invasive cardiac 
procedures and associated costs of circulatory diseases subsequent to the 
emergency room visits up to two years of follow-up. RESULTS: A total of 172,627 
met the inclusion criteria. Of those, 23.30% enrollees (40,219) had ER visits. 
Group1 included 28.1% of the total patients, group2 included 66.77%, group3 
included 1.13% and group4 included 4.04%. The highest percentage of PTCA and 
CABG procedures were observed in group3 (13%, 11.7%) followed by group4 (7.9%, 
1.7%), group1 (4.7%, 1.4%) and group2 (4.2%, 0.99%). The highest percentage of MI 
were observed in group3 (21.9%) followed by group4 (5.7%), group2 (4, 4.1%) and 
group1(3.3%). Group3 had also the highest cost associated with circulatory 
diseases with a median of ($12,084) followed by group4 ($1,496), group1($1,154) 
and group2 ($915). CONCLUSIONS: Based on the preliminary descriptive 
statistics, patients admitted to observation units, in our population, had  
the lowest percentage of cardiac invasive procedures and circulatory  
diseases associated costs at two years of follow-up after an initial ER visit with 
chest pain.  
 
PHS94  
IMPACT OF ADVERSE DRUG EVENTS ON HOSPITAL LENGTH OF STAY AND 
HOSPITALIZATION COSTS IN HOSPITALS FOR 2003-2009 IN THE UNITED 
STATES  
Lee SM1, Kim CM2, Lim SJ1, Suh DC1 
1Chung-Ang University, Seoul, South Korea, 2Catholic University College of Medicine, Seoul, 
South Korea  
OBJECTIVES: To assess the effects of adverse drug events (ADEs) as the reason 
for admission on hospital length of stay (LOS) and hospitalization costs in  
US hospitals. METHODS: The study used the Nationwide Inpatient Sample of  
the Healthcare Cost and Utilization Project for 2003-2009. ADEs were defined as 
drug poisoning due to inappropriate medication uses or errors and adverse 
effects from drugs administered. A case-control matching method was used to 
determine LOS and hospitalization costs attributable to ADEs. For each case 
patient, one control patient was matched based on sex, age(±5 years), race, exact 
diagnosis, same hospital and same calendar year of discharge. LOS and 
hospitalization costs attributable to ADEs were estimated using the recycled 
prediction method. This method predicted outcomes for patients with ADEs  
by calculating outcomes using estimated coefficients from all sample  
using generalized linear model after adjusting for the study variables. Then,  
LOS and hospitalization costs attributable to ADEs were defined as  
the differences between the predicted outcomes assuming the patients  
with ADEs as having ADEs and the predicted outcomes assuming the patients 
with ADEs not having ADEs. All costs were converted to 2011 US dollars using 
consumer’s price indices and calculated per-discharge. RESULTS: A total of  
6076 patients with ADEs were matched with control patients. The matched 
control patients had a mean LOS of 4.50 days versus 4.85 (p<0.05) for patients 
with ADEs. The average hospitalization cost for control patients was  
$7648 compared to $7785 for patients with ADEs. The LOS attributable to ADEs 
was 0.36 days per admission and the mean hos-pitalization cost attributable to 
ADEs was $550 per admission. CONCLUSIONS: The incidence of ADE 
significantly increases LOS and hospitalization costs. To reduce these outcomes, 
it is necessary that a systematic approach to improve drug use process is 
undertaken including the monitoring of ADEs as an important outcome of 
pharmacotherapy.  
 
PHS95  
INCREMENTAL HEALTH CARE RESOURCE UTILIZATION ASSOCIATED WITH 
AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE  
Iyer NN1, Vendetti NJ2, Levy DI2, Thomas III J1 
1Purdue University, College of Pharmacy and Regenstrief Center for Healthcare Engineering, 
Center for Health Outcomes Research and Policy, West Lafayette, IN, USA, 2Pfizer, Inc., 
Collegeville, PA, USA  
OBJECTIVES: Incremental health care resource utilization associated with 
autosomal dominant polycystic kidney disease (PKD) was estimated. METHODS: 
Study data were from a large administrative claims and enrollment database. 
Individuals 18 y/o or older, enrolled in tracked health plans for 12 months from 
April 1, 2011 through March 31, 2012, and with an ICD-9-CM diagnosis code for 
“polycystic kidney, autosomal dominant” (753.13) or for “polycystic kidney, 
unspecified type (753.12) were identified as having autosomal dominant PKD. A 
comparison group of individuals who met all inclusion criteria except were not 
classified as having autosomal dominant PKD, autosomal recessive PKD, cystic 
kidney disease, chronic kidney disease stage 3 or higher, nephrotic syndrome, 
diabetic kidney disease or kidney stones associated with cystic kidney disease 
was matched one-to-one with individuals with PKD on age and gender. Zero-
inflated negative binomial models estimated associations between PKD and hos-
pitalizations, hospital days, nursing home stays, nursing home days, inpatient 
psychiatric hospital stays, inpatient psychiatric hospital days, emergency room 
visits and outpatient visits, after adjusting for age, gender, Charlson co-
morbidity index, cardiovascular disease, diabetes and geographical region. 
RESULTS: A total of 3844 individuals with PKD, satisfied selection criteria and 
were matched with 3844 individuals without PKD. The sample was 53% female 
and 55% were between 45 to 64 years old. The PKD group was more likely to have 
cardiovascular disease (25.6% vs. 13.3%, p<0.001), diabetes (14.1% vs. 10.0%, 
p<0.001) and Charlson comorbidity index scores greater than zero (55.8% versus 
37.5%, p<0.001). Autosomal dominant PKD was associated with marginally more, 
mean (standard error), hospitalizations 0.09 (0.01), p<0.001, hospital days 0.68 
(0.08), p<0.001, emergency room encounters 0.29 (0.06), p<0.001 and outpatient 
encounters 6.9 (0.28), p<0.001. CONCLUSIONS: Autosomal dominant PKD was 
associated with incrementally greater health care resource utilization especially 
for outpatient encounters.  
 
PHS96  
HEALTH CARE USE AND EXPENDITURES IN DIABETES PATIENTS WITH  
CANCER  
Alfaifi A1, Lai L2 
1Nova Southeastern University, Plantation, FL, USA, 2Nova Southeastern University,  
Ft. Lauderdale, FL, USA  
OBJECTIVES: To investigate the prevalence of cancer comorbidity in individuals 
with diabetes, and its association with health care use and expenditures. 
METHODS: Our study was conducted with a quasi-experimental design ap-
proach. Subjects included patients who reported having diabetes from the 2010 
Medical Expenditure Panel Survey (MEPS). The propensity scores technique was 
utilized to match patients with cancer versus without cancer to reduce selection 
bias in observable risk factors such as age, sex, race/ethnicity, physical activity, 
smoking and body mass index. Further, a series of weighted inferential statistics 
were used to test the effect of cancer comorbidity on the variables associated 
with health care use and expenditures. All analyses were accomplished by 
taking into consideration with MEPS sample clustering, stratification, and weight 
adjustments using SAS 9.22 analytical software. RESULTS: There were an 
estimated 21.03 million non-institutionalized adults who reported having 
diabetes in the US in 2010, of which, 3.89 million (18.5%) had cancer comorbidity. 
Individuals with diabetes were twice as likely as a comparable sample from the 
general US population to be diagnosed with cancer (odds ratio 2.1, 95% CI 1.9–
2.49). Variables associated with health care use and expenditures (total office-
based use and expenditures, outpatient department use and expenditures, 
emergency facility use and expenditures, prescription medication use and 
expenditures, etc.) for individuals with cancer were significantly higher than 
those without cancer (p< 0.0001). CONCLUSIONS: Our study findings indicate the 
cancer individuals with diabetes are associated with increased health care use 
and expenditures. The major implementation may be benefit from early 
identifying selected diabetes patients because they seem to be at higher risk for 
cancer.  
 
PHS97  
 
 
WITHDRAWN  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


PHS94 Impact Of Adverse Drug Events On Hospital Length Of Stay And Hospitalization Costs In Hospitals For 2003-2009 In The United States 

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PHS94 Impact Of Adverse Drug Events On Hospital Length Of Stay And Hospitalization Costs In Hospitals For 2003-2009 In The United States

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