Elevated apoB48-containing remnant lipoprotein is a stronger biomarker for paediatric CVD risk compared to traditional cholesterol parameters and may be associated with early adaptation of the intestine during obesity. Further investigation of abnormalities associated with the secretion and/or clearance of atherogenic remnant lipoproteins during the postprandial state may yield insight into our understanding of and therapeutic targets for managing risk for CVD in children with obesity.

OBJECTIVE: Salmeterol, a long acting beta‐2 agonist, improves lung function and symptom control with twice daily dosing in moderate‐to‐severe asthmatics. This investigation was performed to determine whether the introduction of salmeterol to moderate‐to‐severe asthmatics in a Medicaid fee‐for‐service population reduces the overall asthma related health care expenditures. METHODS: The New Mexico Medicaid fee‐for‐service claims database was searched between 1/1/94 and 12/31/98 to identify both a salmeterol and control group. The inclusion criteria for the salmeterol group were: patients receiving salmeterol, who were 66% compliant with salmeterol therapy, had a diagnosis of asthma (ICD‐9: 493.0, 493.1, 493.9), were 13 years of age or older, did not have a diagnosis of COPD (ICD‐9: 496.x) and must have been Medicaid eligible for 2 consecutive years. In addition to the above criteria for the salmeterol group, to be included in the control group, patients must not have received salmeterol between 4/12/95 and 4/12/97 (around the median start date of salmeterol, 4/12/96), and in order to match for severity must have received other asthma maintenance medications. Patients meeting these criteria for the salmeterol and control groups were 57 and 58, respectively. ANCOVA were performed to compare costs between the two groups controlling for baseline costs. Average per patient benefit‐cost ratios were calculated by dividing total cost savings by increase in medication costs for both groups. RESULTS: No significant difference existed among average per patient total health care expenditures between the salmeterol and control groups ($2266 and $1955, respectively). Interestingly, in the salmeterol group, total medication costs increased significantly (t = −7.895, p = 0.000) while total health care costs decreased, although not significantly. The average per patient benefit‐cost ratio for the salmeterol group was 0.061 ($41/$668). CONCLUSION: Introduction of salmeterol in the New Mexico Medicaid fee‐for‐service population did not significantly reduce total asthma related health care costs.

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OBJECTIVE: Continuous blood glucose monitoring which requires the use of blood glucose test strips (BGTS) is essential for diabetes management. The objective of this study was to identify predictors of claims for BGTS submitted to the New Mexico Medicaid fee‐for‐service (NMMFFS) program. METHODS: Patients with prescription claims for insulin or oral diabetic medications between December 1, 1999 and November 30, 2000 were identified from the NMMFFS claims database. It was determined if these patients had claims for BGTS. Information on demographic predictors including age, gender, race/ethnicity, insulin use, and area of residence (rural, urban, intermediate) were extracted. A forward stepwise logistic regression analysis using the likelihood‐ratio (LR) test, was performed to identify significant predictors of claims for BGTS. RESULTS: A total of 5636 diabetic patients, mean age 65.93 (SD = 17.25), were identified. Of these, 38.6% (n = 2178) had claims for BGTS. About 70% (n = 3974) were female, 45.1% (n = 2543) had claims for insulin, and 38.8% (n = 2185) resided in an urban area. Additionally, there were 42.7% (n = 2408) non‐Hispanic whites, 30.8% (n = 1738) Hispanics, and 9.2% (n = 519) American Indians. The logistic regression results indicated that younger patients (OR = 0.97, 95% CI = 0.97–0.98) and patients with claims for insulin (OR = 1.88, 95%CI = 1.68–2.11) were more likely to have claims for BGTS. However, males (OR = 0.64, 95% CI = 0.56–0.73), patients who lived in intermediate areas (OR = 0.74, 95% CI = 0.65–0.83), non‐Hispanic whites (OR = 0.78, 95% CI = 0.67–0.91), Hispanics (OR = 0.63, 95% CI = 0.53–0.75) and American Indians (OR = 0.40, 95% CI = 0.32–0.51) were all less likely to have claims for BGTS. CONCLUSIONS: Elderly patients who are female, non‐insulin users, non‐Hispanic white, Hispanic or American Indian and live in intermediate areas are less likely to have claims for strips. Therefore, educational interventions are needed to increase claims for BGTS in these patients, thus improving blood glucose monitoring.

OBJECTIVE: To obtain a profile of adult patients at risk for nonsteroidal anti‐inflammatory drug (NSAID) induced gastrointestinal (GI) complications in a large managed care health plan in the Southwest United States. METHODS: Patients with NSAID prescription claims between July 1996 and June 1997 were identified from a health plan claims database. Patients with claims associated with ICD‐9 and CPT codes indicating serious GI complications were then identified. The ICD‐9 codes used were those associated with GI ulcers (531.x, 532.x, 533.x, and 534). A total of 19 CPT codes for GI procedures indicative of a GI complication were used. A forward stepwise logistic regression analysis, using the likelihood‐ratio (LR) test, was performed to identify predictors of GI complications. Predictors included in the model were individual NSAIDs and the following potential risk factors: age, gender, previous GI drug usage, previous steroid usage, and total days supply of NSAIDs during the study period. RESULTS: A sample of 15,772 patients with prescription claims for NSAIDs was identified. Of these patients, 213 (1.4%) had an ICD‐9 or CPT code suggestive of serious GI complications secondary to a NSAID. The logistic regression results indicated that women (OR = 0.65, 95% CI = 0.48–0.87) were less likely to develop GI complications. However, patients with previous GI drug usage (OR = 5.97, 95% CI = 4.51–7.90), those who used ketorolac (OR = 2.01, 95% CI = 1.10–3.67) and those who used oxaprozin (OR = 1.82, 95% CI = 1.10–3.00) were more likely to develop GI complications. CONCLUSION: Users of ketorolac and oxaprozin, as well as those with previous GI drug usage were at a higher risk, while women were at a lower risk of GI complications in this managed care population.

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