A comparison of abciximab use in MCO and non-MCO populations

Objective: To compare abciximab use in managed care organization (MCO) pati ents and non-MCO patients undergoing coronary angioplasty, specifically (1) the factors influencing abciximab use, (2) the impact of abciximab on hosp ital length of stay (LOS), and (3) differences in results in MCO and non-MC O patients. Study Design: A retrospective observational study based on data from 87 US hospitals on 13,384 angioplasty patients. Patients and Methods: Multivariate analysis was used to control for a wide range of factors (patient demographics, health conditions, admission inform ation, and hospital characteristics) that may influence the likelihood of r eceiving abciximab and hospital length of stay (LOS). Estimation was conduc ted via a 2-stage sample selection model. Results: Comorbidities, hospital characteristics, and geographic regions in fluenced abciximab use in MCO and non-MCO populations. In the non-MCO popul ation, women and minority group members were significantly less likely than white male patients to receive abciximab. Both MCO and non-MCO angioplasty patients who were given abciximab had significantly shorter LOSs (0.66 +/- 0.27 fewer days and 0.87 +/- 0.13 fewer days, respectively) than did patie nts who were not given this drug. Conclusions: Access to care for MCO and non-MCO populations differed. Non-M CO women and minorities were less likely than non-MCO white men to receive abciximab, but this difference was not observed in the MCO population. Afte r controlling for high-risk indications and selection bias, MCO and non-MCO patients who received abciximab had significantly shorter LOSs than did th ose who did not receive abciximab. This finding is consistent with the many clinical trials that have observed a reduction in ischemic complications a ssociated with abciximab use.