Health care resource utilization among patients starting ACEI and ARB therapy

Abstract

Medical and pharmacy claims from a database containing more than 2.5 million covered lives were examined to evaluate the costs of outpatient laboratory and physician visits, hospitalizations, and ER visits among patients initiating angiotensin converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB), ACEI-diuretic combination, and ARB-diuretic combination. Continuously enrolled members (1/1/97 to 8/30/99) with at least one ICD-9 diagnosis code for hypertension, no claims for antihpertensive drug in 1997, and at least one claim for an ACEI, ACEI-diuretic, ARB, ARB-diuretic therapy filled between Jan 1, 1998 and August 30, 1999 were followed for 12 months after initial prescription fill. Patient demographics, cardiovascular comorbid conditions and costs of health care utilization (outpatient laboratory and physician visits, hospitalizations, and ER visits) were assessed. There were 3,725 ACEI patients, 426 ACEI-diuretic patients, 1,112 ARB patients, and 302 ARB-diuretic patients identified. The average age of patients in all groups was similar (57-59). The majority of patients starting ACEI and ARB were males (51% and 56%, respectively). Patients starting ACEI-diuretic and ARB-diuretic were mainly females (56% and 53%, respectively). Except for diabetes, baseline cardiovascular comorbid conditions were similar for all drug classes. Diabetes (17.4%) was more prevalent with ACEI patients than were ARB patients (10.8%) and similarly for ACEI-diuretic (12.2%) and ARB-diuretic (5.6%) patients. The average annual total costs of health care utilization per patient were $2551 for ACEI versus $2329 for ARB and $1665 for ACEI-diuretic versus $1411 for ARB-diuretic. Lower cardiovascular and non-cardiovascular hospitalizations contributed to the lower total health care costs associated with ARB therapy. When averaged over all groups, hospitalization accounted for 71.8%; outpatient physician visits accounted for 21.3%; ER visits accounted for 2.4%; and outpatient laboratory accounted for 4.5% of the total costs. This analysis suggests that patients initiating ARB therapy had lower total health care resource utilization costs one year following initiation of therapy.