Axelsen, K

Mark, T

Mucha, L

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A20 Abstracts
9.8 days) and PVT (7.7 ± 8.4days), compared with AMI patients
without ventricular arrhythmia (5.5 ± 6.1 days). Average hospi-
talization costs were signiﬁcantly higher (p < 0.001) in AMI
patients with sustained VT/VF ($26,524 ± 29,869) and PVT
($23,447 ± 27,704) than those for AMI patients without ven-
tricular arrhythmia ($14,449 ± 16,638). CONCLUSIONS: Ven-
tricular arrhythmia in AMI patients was associated with higher
mortality and increased resource utilization. Prevention of ven-
tricular arrhythmia in AMI patients would potentially yield ben-
eﬁts of increased survival and reduced costs.
CV3
SWITCHING,AUGMENTATION AND TITRATION OF LIPID
LOWERING AGENTS OF MEDICARE/MEDICAID DUAL
ELIGIBLE PATIENTS BY ETHNICITY
Mucha L1, Mark T2,Axelsen K3
1Thomson Medstat, Cambridge, MA, USA, 2Thomson, Washington,
DC, USA, 3Pﬁzer Global Pharmaceuticals, New York, NY, USA
OBJECTIVES: The objective of this study was to examine 
prescribing patterns of lipid lowering agents among Medic-
aid/Medicare dual eligible patients by ethnicity. METHODS:
Data came from the Thomson Medstat Marketscan® Medicare
and Medicaid claims databases. Beneﬁciaries who were pre-
scribed these agents during 2003 and enrolled for the full year
in both databases were in the study sample. Logistic regression
models estimated the probability of a switch, augmentation, or
titration up, by ethnicity. Switching was a change in the agent,
augmentation was at least 30 days of overlapping therapy, and
titration upwards was an increase in dosage for two consecutive
prescriptions. RESULTS: There were 239,530 patients included
in the study. Fewer African Americans (9%) switched lipid low-
ering agents than Asians, Hispanics, Caucasians or other eth-
nicities (14%, 13%, 12%, and 13%, respectively) did. Fewer
African Americans (3%) augmented with another agent than
Asians, Hispanics, Caucasians or others (6%, 5%, 6% and 5%).
Logistic regressions showed that African Americans were signif-
icantly less likely to switch (OR 0.68; 95% CI 0.60–0.78),
augment (OR 0.53; 95% CI 0.43–0.66), or titrate up (OR 0.75;
95% CI 0.67–0.84) than Caucasians, controlling for age, gender,
state of residence, days on therapy, number of outpatient visits,
and the Chronic Disease Score. CONCLUSIONS: Results were
consistent with the literature which shows lipid lowering agent
prescribing for African Americans tended to be less aggressive,
as evidenced by fewer switches, less augmentation and less
upward titration. This may reﬂect treatment differentials such as
clinicians being less likely to increase doses of lipid lowering
agents to help these patients reach goal. It may also reﬂect the
effectiveness of these agents in lowering lipid levels and keeping
patients at consistently low levels. These treatment issues merit
further observation as dual eligibles move into Medicare part D
plans with differing coverage and formulary restrictions.
CV4
MANAGING CONGESTIVE HEART FAILURE: COHORT
ANALYSIS OF USE AND COST OF HOSPITAL, EMERGENCY
DEPARTMENT AND OBSERVATION UNIT CARE OVER 
TWELVE MONTHS
O’Brien JA, Duran PA, Pitoniak-Morse C, Caro JJ
Caro Research Institute, Concord, MA, USA
OBJECTIVES: Examine use and cost of inpatient, emergency
department (ED), and observation unit (OU) services during one
year by patients treated for congestive heart failure (CHF).
METHODS: Using 2001–2002 Massachusetts hospital, ED and
OU data, a cohort of adult patients (age: 18+ years) with CHF
(ICD-9 principal diagnosis code: 428.0–428.9) was identiﬁed. A
patient CHF encounter proﬁle was established starting with the
ﬁrst stay/visit (index encounter) at any hospital, ED or OU in
2001 and included all subsequent inpatient, ED or OU care for
CHF within 12 months. Charges (accommodations, ancillary
services) adjusted by a 0.55 cost-to-charge ratio, medical inﬂa-
tion and geographic factors are reported as 2005 US$ costs.
RESULTS: The patient cohort (n: 18,550; females: 56%; mean
age: 61 years, range: 18–104) used a combined total of 28,673
CHF-related hospitalizations, ED and OU stays during one year
(mean encounters: 1.5, range: 1–29). Of all encounters, 84%
were inpatient, 12% ED and 4% OU. Only inpatient care was
used by 79% of the cohort (mean stays: 1.4, range: 1–16); 8%
ED only (mean visits: 1.1, range: 1–19); 3% OU only (mean
stays: 1.1, range: 1–3); 9% used multiple care settings (mean
encounters: 3, range: 2–12); and 1% used all (mean encounters:
5.2, range: 3–29). Patients with inpatient plus ED or OU care
had a signiﬁcantly (p < 0.01) greater readmission rate (44%) for
CHF than those utilizing only inpatient care (26%). On average,
hospital length of stay was 5.4 days, cost: $7736; ED visit: 4.7
hours, cost: $740; OU stay: 29 hours, cost: $2468, per encounter.
Cumulative cost for hospital, ED and OU care for one year was
roughly $190 million. CONCLUSIONS: Inpatient care was the
dominant non-routine setting for acute management of CHF.
Those utilizing multiple acute care locations are more likely to
have multiple hospitalizations within one year.
INFECTIOUS DISEASE
ID1
“GATEKEEPERS AND SENTINELS”: IMPLICATIONS FOR DRUG
UTILIZATION POLICY IN THE COMMUNITY SETTING
Kahan NR1,Waitman DA1, Kahan E2, Chinitz DP3
1Leumit Health Fund,Tel-Aviv, Israel, 2Tel-Aviv University, Kfar Saba,
Israel, 3The Hebrew University of Jerusalem School of Public Health,
Jerusalem, Israel
OBJECTIVES: Prior authorization (PA), the requirement of
physicians to obtain pre-approval as a prerequisite for coverage
may decrease drug utilization via a “sentinel effect”, a decrease
in utilization caused by external review of prescribing. The
purpose of this study was to assess the affect a PA restriction had
on the utilization patterns of cefuroxime tablets in a Managed
Care Organization (MCO) in Israel. METHODS: Prescribing
patterns were evaluated from electronic patient records. A ret-
rospective drug-utilization analysis was conducted. All prescrip-
tions for solid state antibiotics for patients diagnosed with an
infectious disease during three parallel, three month segments:
before, during, and after a PA restriction for cefuroxime was
enforced were included. Frequency and proportion of antibiotic
prescriptions for cefuroxime, distribution of infectious diseases
treated with cefuroxime, and the request rejection rate when PA
was required were calculated. RESULTS: Prescription of
cefuroxime declined from 5538 (8.0% of eligible antibiotic pre-
scriptions, 95% CI = 7.8, 8.2) in the initial period to 1036
(1.2%, 95% CI = 1.1, 1.3) during the PA period, rising to 3961
(4.3%, 95% CI = 4.2, 4.4) in the post-PA period. Changes in the
distribution of diseases treated with cefuroxime during the PA
stage tended to regress after revocation to those observed in 
the pre-PA period. The rejection rate was 8.5% (95% CI =
6.9–10.1). CONCLUSIONS: Although a PA requirement for
cefuroxime markedly reduces utilization probably due to a “sen-
tinel effect”, it will not lead to residual effects on prescribing
behavior upon its revocation, indicating the need for a multi-
pronged approach in the realm of policy, regulation and man-
agement regarding prescribing behavior. While many articles
have alluded to the need to create a “culture of quality”, we


CV3 SWITCHING, AUGMENTATION AND TITRATION OF LIPID LOWERING AGENTS OF MEDICARE/MEDICAID DUAL ELIGIBLE PATIENTS BY ETHNICITY 

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CV3 SWITCHING, AUGMENTATION AND TITRATION OF LIPID LOWERING AGENTS OF MEDICARE/MEDICAID DUAL ELIGIBLE PATIENTS BY ETHNICITY

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