De Lissovoy, G

Fraeman, KH

Reynolds, MW

Vaughn, B

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PCV106 PATIENT OUTCOMES AND HEALTH ECONOMICS ASSOCIATED WITH THE USE OF OCTYLCYANOACROLATE TOPICAL SKIN ADHESIVE IN CABG SURGERY 

technological innovation have to be taken. To reach this goal, the
paper takes a case-study approach, i.e. surgical ablation (SA)
performed in concomitance with cardiac surgery procedures.
METHODS: An observational, retrospective, multi-centre study
was carried out. Three hospitals were selected based upon the
volume of activity (i.e. >50 SA procedures/year). Patients
(N = 311) were enrolled during a 16-month period and recruited
if they met inclusion criteria. Health care resource consumption
was measured in detail through a bottom-up micro-costing
approach. RESULTS: Direct and full costs of SA and of the
concomitant cardiac surgery procedures were calculated per
patient by using a standard costing approach. Mean direct cost of
surgical interventions (SA and the concomitant procedures) is
€9093 (range: 6406–14,746). While there is a large homogeneity
among centres as to costs of SA (mean €1889), signiﬁcant differ-
ences (p < 0.05) emerge in costs of concomitant interventions
(mean €7204) mainly because of different organisational pat-
terns. CONCLUSIONS: Hospital managers are struggling to face
the tension between scarcity of resources and increasing health
care needs. Technological innovation opens new opportunities
for hospital activities and patients’ health that however need to
be assessed against its costs. Which cost (i.e. direct vs. full
costing) is to be considered in the decision-making process
however is still not clear. There is a tendency to consider full
costing of new procedures and to decide whether they are ﬁnan-
cially sustainable by contrasting it to the relevant DRG(s).
Nevertheless, it is here argued that ﬁrstly, direct costing better
illustrates the true economic value of the innovative procedures
and therefore should be primarily used, and secondly, ﬁnancial
hospital sustainability would need to be assessed based upon
hospitals’ case-mix and not in silos.
PCV104
EVALUATION OFTHE PRESCRIPTION PATTERNS OF STATINS
THROUGH APPROPRIATE INDICATORS INTWO ITALIAN
LOCAL HEALTH UNITS IN 2004–2006
Lopatriello S1, Salvato C2, Maccari D2, Palcic S3, Broussard P3,
Negrini C4
1Pbe Consulting,Verona, Italy, 2ASL 7 Pieve di Soligo (TV), Pieve di
Soligo, Italy, 3A.S.S. 1 “Triestina”, S.C. Assistenza farmaceutica,Trieste,
Italy, 4Pbe Consulting, Milano, Italy
OBJECTIVES: Drug therapy should be appropriately prescribed
and administered in order to efﬁcaciously prevent cardiovascu-
lar events. The study aim was to describe the prescriptions of
statins in terms of persistence and compliance with the purpose
of identiﬁng appropriate pharmaco-epidemiological indicators
close to clinical practice. METHODS: Statins (ATC C10AA)
prescriptions data were collected from administrative databases
in two Local Health Units (LHUs) in Northern Italy. Eligible
patients should have had at least one statin prescription in three
consecutive years (2004–2006). The adopted indicators for drug
utilization included: “Calendar Days (CD)”, calculated as the
difference between the last and the ﬁrst prescription dates in
each year; “PDD days (PDDd)”, calculated as the ratio between
total mg prescribed and the surrogated prescribed daily doses;
“DDD days (DDDd)”, calculated as the ratio between total mg
prescribed and the deﬁned daily dose. A Compliance to Therapy
Index (CTI) was calculated as the ratio between the total PDDd
and the CD: indexes were calculated for each patient and clas-
siﬁed in four compliance categories (25%, >25% & 50%,
50% & 75%, >75% & 100%). RESULTS: Indicators
showed an increase in statins use over the study period in terms
of both DDD and sPDD. Persistence to therapy for at least two
years was around 50% in both LHUs. PDDd was a more reli-
able measure of the daily dosage in comparison with DDDd,
which resulted in a coverage period longer than the CD. CTI
analysis showed a decrease in low compliance categories
(patients in the range 25%–50% decreased from 26% to 17%)
and a raise in the rate of compliant patients (from 48% to
57%). Single prescriptions increased from 1% to 5%. CON-
CLUSIONS: Although statins’ use is steadily growing, poor
patients’ persistence and adherence to therapy would need the
implementation of strategies to improve compliance with lipid
lowering medications.
PCV105
STATIN PRESCRIBING INTHE CITY OF ZAGREB (2001–2006)
ANDTHEIR ROLE IN SECONDARY PREVENTION OF
CARDIOVASCULAR EVENTS
ŠTimac D, Culig J
Zagreb institute of Public Health, Zagreb, Croatia
OBJECTIVES: Cardiovascular drugs account for 40% of total
outpatient drug utilization in the City of Zagreb. Among them,
utilization of the group of hypolipemics showed greatest rise
from 2001 to 2006. The aim of the study was to investigate
outpatient utilization of hypolipemics in the City of Zagreb
during the 2001–2006 period and to assess the quality of pre-
scribing these drugs in primary health care. METHODS: The
number of deﬁned daily doses (DDD) and DDD per 1000 Zagreb
inhabitants per day (DDD/1000/day) were calculated on the
basis of data on the number of packages of each individual
hypolipemic (C10) for each study year. Data on the rate of
hospitalization for the leading cardiovascular complications were
collected as indirect indicators of the quality of prescribing
statins. RESULTS: The utilization of hypolipemics was 33.03
DDD/1000/day in 2001 and 72.38 DDD/1000/day in 2006,
yielding an almost twofold rise. Two drugs, simvastatin and
atorvastatin, predominated in the utilization of statins with 93%.
From 2001 to 2006, the utilization of simvastatin showed a 30%
increase and that of atorvastatin more than sevenfold increase.
During the study period, the overall rate of hospitalization for
cardiovascular disorders decreased by 18.5%. CONCLUSIONS:
The decreasing tendency recorded in hospitalization for cardio-
vascular diseases points to the improved quality of secondary
prevention, including statins. The growing trend observed in the
utilization of atorvastatin vs. simvastatin is indicative of the still
inappropriate prescribing practice, whereas the high rate of hos-
pitalization for hypertension reﬂects inadequate primary preven-
tion of cardiovascular disorders.
PCV106
PATIENT OUTCOMES AND HEALTH ECONOMICS
ASSOCIATED WITHTHE USE OF OCTYLCYANOACROLATE
TOPICAL SKIN ADHESIVE IN CABG SURGERY
Fraeman KH1, Reynolds MW2,Vaughn B3, De Lissovoy G1
1United BioSource Corporation, Bethesda, MD, USA, 2United
BioSource Corp, Medford, MA, USA, 3ETHICON, Inc, Somerville, NJ,
USA
OBJECTIVES: This study examined the effect of Octylcyanoac-
rolate topical skin adhesive (DERMABOND Topical Skin
Adhesive) on the risk of surgical site infection (SSI) and other
clinical outcomes and resource utilization in patients undergo-
ing coronary artery bypass graft (CABG) surgery. METHODS:
This study utilized the Premier Perspective(tm) Comparative
Database, which includes over ﬁce million hospital discharges
per year. Qualifying patients who underwent CABG surgery
during 2005 and 2006 were identiﬁed. Patients were classiﬁed
into four groups by method of surgical wound closure (sutures
only; sutures/DERMABOND; sutures/staples; and sutures/
staples/DERMABOND). The primary study outcome was the
A414 Abstracts
occurrence of a surgical site infection (SSI) examined by wound
closure method. Post-CABG SSIs were identiﬁed by ICD-9,
DRG, and APR-DRG codes during the initial hospital admis-
sion and re-admissions within 2 months of the initial hospital-
ization, as well as exposure to antimicrobial drugs from post-
operative day 9 to 60 during the initial hospital admission.
RESULTS: A total of 59,006 patients qualiﬁed for the study;
38,799 sutures only, 10,262 sutures/DERMABOND, 8180
sutures/staples, and 1765 sutures/staples/DERMABOND. The
groups were similar at baseline regarding patient and disease
characteristics. The lowest rate of post-CABG SSI was found in
the sutures/DERMABOND group (4.3%, 95% CI = 3.9%–
4.7%), followed by sutures only (5.3%, 95% CI = 5.1%–
5.5%), sutures/staples (6.2%, 95% CI = 5.7%–6.8%), and
sutures/staples/DERMABOND (7.1%, 95% CI = 6.0%–8.4%).
The mean (median) hospitalization cost for all patients without
post-CABG SSI was $28,061 ($25,527), compared to $47,874
($40,062) for all CABG patients who developed SSI. CON-
CLUSIONS: The results of this study suggest that the use of
both DERMABOND Topical Skin Adhesive and sutures for
wound closure following CABG surgery reduces the rate of SSI
and improves clinical outcomes. SSI following CABG surgery
imposes a signiﬁcant economic burden in terms of additional
hospitalization costs.
PCV107
CLOPIDOGREL PATTERNS OF USE IN ACUTE CORONARY
SYNDROME PATIENTS UNDERGOING PERCUTANEOUS
CORONARY INTERVENTION IN FIVE EUROPEAN COUNTRIES
McCollam PL1, Bae JP1, Nasuti PI2,Anger C3
1Eli Lilly and Company, Indianapolis, IN, USA, 2IMS Hospital Group
Ltd, Sittingbourne, UK, 3IMS Health, Kent, UK
OBJECTIVES: The purpose of this study was to determine the
most frequently used clopidogrel dosing regimen in the hospital
setting for acute coronary syndrome (ACS) patients undergoing
percutaneous coronary intervention (PCI). METHODS: This
was a retrospective study using the IMS Health Acute Cardio-
vascular Analyzer. This is an ongoing physician-reported registry
dating from 2005 in Germany, France, Italy, Spain and the UK.
Data collection timeframe reported here was December 2006–
November 2007. The standard dose clopidogrel group was
deﬁned as 300 mg. Demographic and health characteristics
were compiled for the entire cohort and by country. Study data
are shown as summary (or descriptive) statistics. RESULTS:
There were 4455 ACS patients who received clopidogrel and
underwent PCI. Patient count by country was: Germany
(n = 1098), France (n = 1022), Italy (n = 864), Spain (n = 804),
UK (n = 667). Mean age was 63.7  22.9 (SD) years, 46% were
age >65; 71% were male. Common co-morbidities and risk
factors were: hypertension 66.8%, dyslipidemia 74.6%, diabetes
30.6%, prior myocardial infarction (MI) 12.9%. Medications
prior to admission were: clopidogrel 15.9%, statins 34.8%,
aspirin 61.3%. The index diagnosis was: ST-elevation MI 45.0%,
non ST-elevation MI 33.1% and unstable angina 21.9%. Timing
of clopidogrel administration in relation to PCI was: 59.3%
pre-PCI, 11.8% at PCI and 17.0% after PCI (11.9% not speci-
ﬁed). Loading dose ranged from 75–900 mg. Dosage 300 mg
by country was: Germany 47.9%, France 67.8%, Italy 90.8%,
Spain 85.6%, UK 60.7%. Approximately 95% of patients were
discharged on clopidogrel but planned duration varied widely:
1–3 months (25.7%), 6–12 months (19.7%) are greater than or
equal to 12 months (26.5%). CONCLUSIONS: These 2007 data
indicate many patients received clopidogrel prior to PCI at the
300 mg dose but there was geographic variation. The vast
majority of patients received clopidogrel upon discharge, but the
planned duration of therapy varied widely. These data conti-
nue to be useful benchmarks for later comparison to treatment
guidelines.
PCV108
RISK AND COSTS OFTHE FIRST
HYPERTENSION-ASSOCIATED EVENT, COMPLIANCE AND
PERSISTENCE IN NAÏVE HYPERTENSIVE PATIENTS AFTER
INITIATING MONOTHERAPY
Mathes J1, Kostev K2, Gabriel A1, Pirk O1, Schmieder RE3
1IMS HEALTH, Nuremberg, Germany, 2IMS HEALTH, Frankfurt am
Main, Germany, 3Friedrich-Alexander-University Erlangen-Nürnberg,
Erlangen, Germany
OBJECTIVES: To analyze the risk and costs of the ﬁrst
hypertension-associated event, compliance and persistence in
naïve hypertensive patients after initiating monotherapy with any
of the ﬁrst-line antihypertensive drug classes in Germany.
METHODS: A retrospective cohort study in the IMS Disease
Analyzer database was performed. Study subjects included all
previously untreated hypertensive adults who were free from
hypertension-associated comorbidities and were prescribed
initial monotherapy with angiotensin II receptor blockers
(ARBs), ACE-inhibitors (ACEIs), beta-blockers (BBs), calcium
channel blockers (CCBs) or diuretics. Compliance and persis-
tence were determined for each drug class separately and for the
group of non-ARBs (pooled data) within two years. The risk of
the ﬁrst hypertension-associated event (cardiovascular complica-
tions, new onset diabetes) was analyzed using a Cox regression
model adjusted for sociodemographic variables, compliance and
persistence. Based on these results average costs per event were
estimated from the German statutory health insurance perspec-
tive. RESULTS: A total of 7661 patients were identiﬁed with a
follow-up of at least 2 years. Mean follow-up was 5.6 to 6.3
years. Compliance (0.86 vs. 0.82 and 0.74, respectively) and
persistence (509 days vs. 459 and 324 days) was better with
ARBs (all p < 0.05) than with the group of non-ARBs and diuret-
ics, respectively. The risk of the ﬁrst hypertension-associated
event was higher (all p < 0.05) with diuretics (adjusted hazard
ratio (aHR) 0.68), BBs (0.79), CCBs (0.78), and the group of
non-ARBs (0.81) and was similar with ACEIs (aHR 0.93,
p = 0.37) compared to ARBs. Similar ﬁndings were found for
cardiovascular complication rates. The estimated average costs
per event for the ﬁrst event were lower with ARBs (€2339.95)
than with the other drug classes (€2531.68–€3910.47). CON-
CLUSIONS: Our real-world data indicate that initiating mono-
therapy with ARB shows signiﬁcant beneﬁts in most outcomes
including hypertension-related complications compared to other
antihypertensive drug monotherapies.
PCV109
PRESCRIPTION DRUG INSURANCE AND EX ANTE
MORAL HAZARD
Khan N1, Kaestner R2
1University of New Mexico, Albuquerque, NM, USA, 2University of
Illinois at Chicago, Chicago, IL, USA
OBJECTIVES: Economic theory suggests that health insurance
will reduce prevention activities (i.e., ex ante moral hazard). For
instance, prescription drug insurance could result in behavioral
responses that undermine the beneﬁts of increased access to
medication. In this paper, we investigate the relationship between
prescription drug insurance and preventive health behaviors
(physical activity, alcohol consumption, smoking behavior, and
weight) among elderly population. Further, we identify two sub-
groups particularly at risk of substituting prescription drugs for
Abstracts A415


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PCV106 PATIENT OUTCOMES AND HEALTH ECONOMICS ASSOCIATED WITH THE USE OF OCTYLCYANOACROLATE TOPICAL SKIN ADHESIVE IN CABG SURGERY

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