Abstract P204: Clopidogrel Overuse Beyond the Guidelines: Predictors and Financial Outcomes

Background: Clopidogrel is widely used for the treatment and prevention of atherosclerotic events. Due to high cost, overuse of clopidogrel has significant implications on health care costs. The predictors for clopidogrel overuse and it's the financial implications have not been studied. Methods: This is a retrospective chart review done at the Grady Memorial Hospital. We identified 1267 patients from the pharmacy database who had received a prescription for clopidogrel from Jan 2009 to Dec 2010. After excluding patients with atrial fibrillation (n=7) and neurological indication (n=71) for clopidogrel use, 165 charts were reviewed sequentially to determine the indication, duration, cost of the clopidogrel use and factors associated with overuse. Results: The use of Clopidogrel was determined to be appropriate in only half (83/165) patients (group A). Eighty two (50%, group B) patients did not fulfill the criteria of clopidogrel use based on ACC/AHA guidelines 2007. Patients with inappropriately extended use (group B) were significantly older (mean age 67±11 vs. 59±11 years, p<0.001), predominantly female (76% vs. 55%, p<0.005) compared to group A patients. Notably 76% (62/82) of the group B patients had insurance compared to only 34% (28/83) in group A of this predominantly inner city population (p<0.001). Group B patients used clopidogrel for twice the duration compared to Group A (mean 608±239 vs. 300±255 days, p<0.001). Insured patients were nearly four times more likely (OR 3.8, 95% CI 1.6-8.8, p =0.002) than those without insurance to be on clopidogrel for an extended period beyond the guidelines, even after controlling for age, diabetes, total number of coronary lesions and stents. The extended use of clopidogrel incurred significant cost per patient to the hospital ($161±162 vs. $63±128, p<0.001) and to the health care insurance plans ($325±392 vs. $101±240, p<0.001). Conclusion: Nearly 50% of patients received clopidogrel for extended duration beyond the recommended guidelines causing significant costs burden. This practice is seen significantly more often in older, female patients with insurance. Further health care practice reforms are needed to avoid clopidogrel overuse and its financial burden.