OBJECTIVES: As pharmaceutical costs continue to escalate, formulary decisions for hospitals are emerging as a key focus. We conducted a baseline analysis to determine the current costs and clinical outcomes for patients who undergo percutaneous transluminal coronary angioplasty (PTCA) with Heparin at the Center, prior to implementing a new anticoagulant, Bivalirudin. METHODS: Retrospective, observational, analysis of patients discharged from the Washington Hospital Center in 2000 undergoing PTCA. Inclusion criteria included all patients who had an ICD-9 PTCA procedure code and a DRG PTCA code (112 or 116). There were approximately 3400 cases in the study. Age (<65 >), sex, urgency of admission and four co-morbidities were selected a priori for sub-group analyses; diabetes mellitus, acute MI, renal failure and dysrhythmia. Charges were converted to costs using the U.S. CMS cost-to-charge ratio of 0.3574. Economic data and the rates of clinical outcomes were drawn from the Center's patient-level data. Multi-factor regressions were conducted to determine the incremental effects of the four co-morbidities. Statistical significance and confidence intervals were calculated for each endpoint. RESULTS: Average costs from admit to discharge were $7,642 in total and pharmacy was $525 (p value < .05). The geometric mean outcome rates were: death 0.8%, 2nd MI following PTCA 2.4%, revascularization procedures 3.2%, hemorrhage 8.7%, transfusion 3.4% and thrombocytopenia 1.3%. The sub-group with the highest costs and worst clinical outcomes were women, urgently admitted, > 65 years old who had renal failure, acute MI, or dysrhythmia, in descending impact. CONCLUSION: The analyses provide a baseline to assess the future impact of a new medication on the formulary, as well as a basis to evaluate a new business agreement. The economic and clinical analyses will be repeated following the new medication's usage, and will then be evaluated by the Center's healthcare personnel in a group session.