Is Choi

Ethnic/racial variations in blood pressure awareness, treatment, and control.

Understanding the impact of patient factors on blood pressure (BP) management is an important step to developing interventions to improve cardiovascular health. The National Health and Nutrition Examination Survey (NHANES) 1999–2002 was used to identify predictors of hypertension awareness, treatment, and control. An estimated 63.3 million (31.0%) US adults currently have BP exceeding 140/90 mm Hg, and prevalence is higher for blacks than for other racial/ethnic subgroups. Among antihypertensive medication‐treated patients, 51.3% are controlled. Treated blacks and Mexican Americans have the lowest rates of BP control. Mexican Americans are 0.62 times as likely to be aware and 0.61 times as likely to be treated as white persons with hypertension. Compared with whites, treated Mexican Americans are 0.71 times as likely and treated blacks 0.59 times as likely to achieve BP control. Hypertension treatment and BP control in the United States remain suboptimal, and significant racial/ethnic disparities persist. Effective interventions targeting Mexican Americans and blacks as well as whites are essential to improving hypertension management.

Trends in blood pressure control and treatment among type 2 diabetes with comorbid hypertension in the United States: 1988-2004.

Objectives The objectives of this study were to examine the trends in the prevalence of type 2 diabetic patients with comorbid hypertension and blood pressure (BP) control rates in the United States and determine factors associated with these outcomes. Methods We used data from National Health and Nutrition Examination Surveys (NHANES) III (1988–1994) and NHANES 1999–2004, a cross-sectional sample of the noninstitutionalized US populations. Type 2 diabetic patients were identified as patients at least 30 years of age with physician-diagnosed diabetes who were taking insulin or oral antidiabetic drugs to manage the condition. A diagnosis of hypertension was based on physician diagnosis, treatment with antihypertensive medications, or BP at least 140/90 mmHg. BP control was defined as diabetic patients who maintained BP <130/80 mmHg. Logistic regression was used to estimate risks of high BP, and odds of high BP treatment and control rates, after adjusting for demographic and clinical risk factors. Results The age-adjusted prevalence of diabetic patients and those with hypertension increased significantly from 5.8 to 7.1% and 3.9 to 4.7%, respectively, from NHANES III to NHANES 1999–2004. Among diabetic patients with hypertension, patients who were treated with medication or lifestyle or behavioral modification therapy have increased significantly from 76.5 to 87.8% during the observation period. The proportion of patients who controlled BP increased from 15.9 to 29.6%, but 70% of patients still did not meet the target BP goal. Conclusion Aggressive public health efforts are needed to improve BP control in type 2 diabetic patients with hypertension.

Incidence and treatment costs attributable to medication errors in hospitalized patients.

BACKGROUND A significant financial burden arises from medication errors that cause direct injury and those without patient harm that represent waste and inefficiency. OBJECTIVE To estimate the incidence, types, and causes of medication errors as well as their attributable costs in a hospital setting. METHODS For a retrospective case-control study, data were collected for 57,554 patients admitted to two New Jersey (U.S. State) hospitals during 2005-2006 as well as hospital-specific voluntary error reports from these two hospitals for the same period. Medication errors were classified into categories of stage, error type, and proximal cause, and the incidence was estimated. The costs attributable to medication errors were calculated using both the recycled prediction method, and the Blinder-Oaxaca decomposition method after propensity score matching. RESULTS Medication errors occurred at a rate of 0.8 per 100 admissions, or 1.6 per 1000 patient days. Most errors occurred at the administration stage of the medication use process. The most frequent types of errors were wrong time, wrong medication, wrong dose, and omission errors. Treatment costs attributable to medication errors were in the range of

PDB17 TREATMENT COSTS ATTRIBUTABLE TO BEING OVERWEIGHT OR OBESE IN U.S. DIABETIC PATIENTS: QUANTILE REGRESSION APPROACH

8,439 using the Blinder-Oaxaca decomposition method and

PRS14 MEDICAL AND PRODUCTIVITY COSTS ATTRIBUTABLE TO OBESITY IN WORKING ADULTS WITH ASTHMA IN THE U.S.

8,898 using the recycled prediction method. CONCLUSIONS Medication errors are associated with significant additional costs, even without patient harm. Considering the substantial costs associated with adverse drug events, the elimination of medication errors should be further emphasized and promoted, and guidelines should be developed to facilitate this goal.

Economic Burden of Atopic Manifestations in Patients With Atopic Dermatitis—Analysis of Administrative Claims

from the budget of both payers would raise by 579.5 thousand PLN (130.3 thousand a) in 2009 and 1.2 mln PLN (261 thousand a) in 2010. Depending on parameter changes, the budget would change by 17% and 19% for NHS and both payers perspective, respectively. CONCLUSIONS: The reimbursement of vildagliptin will cause the raise of NHF expenses by 0.37% in 2009 and 0.70% in 2010 of the budget spent for oral drugs reimbursed in diabetes mellitus. For both payers’ perspective, the reimbursement of vildagliptin will cause the raise expenses by 0.27% in 2009 and 0.53% in 2010 of the budget.

Productivity Loss Costs Attributable to Obesity in Working Patients with Diabetes in the US

PRS13 THE CZECH BURDEN STUDY: SUBGROUP ANALYSIS (BURDEN AND QUALITY OF LIFE IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE EXACERBATION) Skoupá J, Kašák V, Blahová M, Cerna V, Malý M Pharma Projects, Prague, Czech Republic, Lerymed s.r.o., Prague, Czech Republic, Thomayer University Hospital, Prague, Czech Republic, National Institute of Public Health, Prague, Czech Republic OBJECTIVES: To estimate 6 months costs and quality of life (QoL) of patients with moderate to very severe COPD (GOLD criteria) who experienced a COPD exacerbation in comparison with control groups of similar COPD severity without exacerbation. METHODS: COPD inand outpatients (Grade II 28; III 31; IV 31) with exacerbation (EXA-groups) were assessed retrospectively (3 month prior to exacerbation) and prospectively (3 month after exacerbation) and compared to controls (COgroups) of similar disease severity but stable health (3 month retrospective assessment). Direct costs included hospitalization, outpatient visits, laboratory tests, imaging, medication and rehabilitation. Indirect costs included short and long term disability payments. All costs were converted to a period of 180 days; health care costs used 2008 prices from the payer’s perspective. A validated translation of the EQ5D was completed at inclusion day (all groups) and at final visit (EXA-groups). RESULTS: About 18% of grade-II and 75% grade-IV exacerbations were hospitalized, resulting in increased costs with COPD severity (6-months median: Grade II a846; III a2159; IV a3856; all p 0.05). Median 6-months costs in CO-groups were lower, although increasing from moderate to very severe COPD (Grade II a567; III a1610; IV a2084; all p 0.05). Exacerbation accounted for 8% (grade-II) to 31% (grade-IV) of total 6-months costs. Mean EQ5D utilities in the CO-groups and in the EXA-groups at final visit were comparable (moderate: 0.589 vs.0.636; severe: 0.623 vs. 0.591; very severe: 0.524 vs. 0.479; NS). Mean EXA-groups utilities at inclusion were significantly lower compared to final assessment (p 0.001) and decreasing with COPD severity (moderate: 0.524; severe: 0.390; very severe: 0.230), reflecting QoL impairment during COPD exacerbation and natural disease course. CONCLUSIONS: The BURDEN study confirmed for the Czech Republic a considerable economic burden of COPD. In accordance with international literature we found increased costs and decreased QoL for 1) COPD exacerbation vs. control in stable state, and 2) COPD progression.