A97 Abstracts of prescriptions, hospitalizations, visits and diagnostic examina- tions in FVG. Direct medical costs were quantified in the per- spective of the RHS and are expressed in Euro 2005. RESULTS: We enrolled 2122 patients with incident CHF (mean age 78 ± 11 y.o.), 55.3% were women. The average cost person/year was €5896, 54; 80% attributable to hospitalisations, 13.7% to drugs, 6.3% to other medical costs. A total of 1320 (62.2%) patients died during the follow-up period. Mortality was higher in male (p < 0.0001) and older subjects (p < 0.0001). CONLUSIONS: CHF imposes a huge economic burden on NHS and society because of the large number of hospitalisation and the high rate of mortality after the first event. Future investigations will be conducted to asses the relationships between comorbidity, costs, drug therapy and survival. PCV28 IMPACT OF MODIFIED SYSTEM OF OBJECTIFIED JUDGMENT ANALYSIS (SOJA) METHODOLOGY ON PRESCRIBING COSTS OF ANGIOTENSIN CONVERTING ENZYME INHIBITORS (ACEIS) Alabbadi I 1 , McElnay J 1 , Crealey G 1 , Scott M 2 , Mairs J 2 1 Queen’s University Belfast, Belfast, UK; 2 United Hospitals Trust, Belfast, UK OBJECTIVE: SOJA is a structured approach to the selection of drugs for formulary inclusion. The aim of this study was to use a modified SOJA approach in the selection of ACEI products for use within a health board in Northern Ireland. METHODS: The modified SOJA approach involved three phases in sequence: an evidence based pharmacotherapeutic evaluation of all available ACEI drug entities, a separate safety / risk assessment analysis of products containing agents which exceeded the pharma- cotherapeutic threshold and finally a budgetary impact analysis. A comprehensive literature review and expert panel judgment, informed selection of criteria (and their relative weighting) for the pharmacotherapeutic evaluation. The resultant criteria / scoring system was circulated (in questionnaire format) to pre- scribers and stakeholders for comment. Based on statistical analysis of the latter survey results, the final scoring system was developed. Drug entities which exceeded the evidence threshold score were entered into a tendering process with pharmaceutical suppliers. Products submitted as a result of the tendering process were sequentially entered into the second and third phases of the modified SOJA process (safety / risk assessment; budgetary impact analysis). RESULTS: Five drug entities (from the 11 cur- rently available in the UK) exceeded the evidence threshold and 22 from 26 submitted product lines, containing these drug enti- ties, satisfied the safety evaluation / risk assessment criteria. Three product lines, each containing a different drug entity, were selected for formulary inclusion as a result of the budgetary impact analysis. The estimated annual cost savings for ACEIs as a result of this selection (based on estimated annual usage in Defined Daily Doses) in this health board was 41%. CONCLU- SION: The modified SOJA approach has a significant contribu- tion to make in containing ACEI costs while retaining the same level of patient care. PCV29 USE OF CONTRAST ECHOCARDIOGRAPHY: A REVIEW OF CLINICAL DATA USING A SYSTEMATIC APPROACH Cottr ell S 1 , Richardson R 1 , Lewis S 1 ,Yankah E 1 , Chambers M 2 1 M-TAG,A division of IMS Health Economics and Outcomes Research, London, UK; 2 GE Healthcare, Amersham, UK OBJECTIVE: Risk assessment is important in determining the management of patients with suspected or confirmed coronary artery disease (CAD). However, evidence supporting the clinical impact of contrast echocardiography (CE) in this sphere is not well known. The objective was to review and summarise the clin- ical data for licensed and investigational applications of CE in CAD, using systematic review methodology. METHODS: Full publications of clinical studies of selected contrast agents were identified through searches of electronic literature databases and application of predefined inclusion criteria. Studies were cate- gorised and key data were extracted and tabulated for analysis. No statistical pooling of data was undertaken due to study het- erogeneity. RESULTS: 2275 abstracts were screened. 61 studies met inclusion criteria and were categorised as follows: effective- ness in image enhancement (23 studies); accuracy in the diagno- sis of CAD, using coronary angiography as the diagnostic gold standard (23 studies); myocardial viability assessment (16 studies); prognostic accuracy (2 studies). Using second genera- tion contrast agents, diagnostic images were obtained in 48–98% (median = 74%) of patients with suboptimal un-enhanced images and several studies reported improved intra- and inter- operator reproducibility. Reported sensitivities and specificities for CAD diagnosis ranged from 41–100% (median = 86%) and 44–100% (median = 81%). Two studies reported that informa- tion gained from myocardial contrast echocardiography (MCE) provided incremental diagnostic value to that from left ventric- ular function (LVF) assessment alone. Reported sensitivities and specificities of myocardial viability assessment by MCE for predicting LVF recovery ranged from 50–96% (median = 74%) and 44–96% (median = 83%). CONCLUSIONS: The body of evidence suggests that effective use of contrast agents in echocardiography extends beyond the licensed use in patients with suboptimal baseline images. MCE is effective in the assess- ment of myocardial perfusion in the diagnosis of CAD and the detection of myocardial viability. Interpretation is limited by the size of studies, lack of long-term outcomes and potential refer- ral bias. PCV30 CLOPIDOGREL LOADING DOSE AND CARDIOVASCULAR OUTCOMES IN ACUTE CORONARY SYNDROME PATIENTS WHO UNDERGO PERCUTANEOUS CORONARY INTERVENTION Wang C 1 , He J 1 , Bae JP 2 , McCollam PL 2 , Griffin BT 1 1 Solucient, Inc, Berkeley Heights, NJ, USA; 2 Eli Lilly and Company, Indianapolis, IN, USA OBJECTIVES: The 2002 AHA/ACC guideline recommends acute coronary syndrome patients who undergo percutaneous coronary intervention (ASC-PCI) be given 300 mg loading dose (LD) of clopidogrel, but higher LD has emerged in practice. A recent trial involving 255 patients found 600 mg of clopidogrel had better outcomes than 300 mg (Patti et al, 2005). The current study investigates whether patients treated with higher clopido- grel LD experience better outcomes in the usual care setting. METHODS: We followed 6,282 ACS-PCI patients in a national hospital database with time-stamp information (1/2003–9/2004) for 60 days upon discharge. Using the time-stamp, LD was mea- sured as total dose within 24-hour window of peri-PCI proce- dure, and myocardial infarction (MI) was captured from post-procedure lab tests. Patients receiving >300 mg are grouped into high LD (HLD) (nH = 1465) and £300 mg, the low LD group (LLD) (nL = 4152). Primary endpoints (i.e., death, stroke, repeat revascularization, and MI) plus bleeding and re-admission were monitored. Logistic regression tested effects of LD on events with controls for risk. RESULTS: LD ranged from 75 mg to 1275 mg. The HLD group did not experience better outcome. While 28.49% of LLD experienced an event, the rate was 44.23% for the HLD (p < 0.0001). MI rate was higher for HLD