@article {Etemad:December 2005:0300-7995:1977,
	author = "Etemad, Lida R.",
	author = "McCollam, Patrick L.",
	title = "Predictors of high-cost managed care patients with acute coronary syndrome",
	journal = "Current Medical Research and Opinion",
	volume = "21",
	year = "December 2005",
	abstract = "<I>Objective:</I> To develop predictive models of high-cost acute coronary syndrome (ACS) patients using demographic, disease, and treatment characteristics.<P></P><I>Study design:</I> This was a retrospective, administrative claims analysis utilizing pharmacy, medical, and eligibility data from a large US managed care organization.<P></P><I>Methods:</I> ACS was defined by ICD-9 codes for unstable angina (UA) or acute myocardial infarction (AMI). New onset patients (without ACS claims) in the prior six months were identified for the time period 07/01/99&#8211;06/30/01, and followed up to 12 months, health plan disenrollment, or death. Cost was measured as that incurred during the initial episode plus subsequent follow-up or during the subsequent follow-up only. Patients were dichotomized as high-cost (top 20%) or low-cost (bottom 80%), based on total costs. Logistic regression was used to examine the association for being classified as high-cost.<P></P><I>Results:</I> A total of 13 731 patients were included: 51.7% with UA, 39.6% with AMI and 8.7% with both UA and AMI. The mean age was 54.2 years and 68.2% were male. A number of co-morbidities (hypertension, diabetes, heart failure, etc.) predicted high-cost patients. Among medications, prior ACE inhibitor use predicted high-cost patients. While revascularization procedures, in general, were strong predictors of high-cost, revascularization during the index ACS episode (opposed to revascularization during the follow-up) decreased the odds of being high-cost (odds ratio [95% CI] 0.615 [0.506&#8211;0.748]).<P></P><I>Conclusion:</I> High-cost patients with new onset ACS can be predicted by some characteristics, but many of these characteristics are non-modifiable co-morbidities. Payers and providers may find opportunities for clinical and cost-saving interventions for these patients.",
	pages = "1977-1984(8)",
	url = "http://www.ingentaconnect.com/content/apl/cmro/2005/00000021/00000012/art00013"
	doi = "doi:10.1185/030079905X74970"
}