'Hidden cost' of nonselective nonsteroidal anti-inflammatory drugs

To investigate the excess risk and costs associated with the major adverse effects of prescription nonsteroidal anti-inflammatory drugs (NSAID), researchers have retrospectively reviewed records for 41,826 patients (over 65 years old).The authors calculated the adjusted rates and costs of major adverse effects associated with nonselective NSAID, including hospitalisation for gastrointestinal (GI) haemorrhage, gastroprotective drug use, ambulatory upper GI procedures, antihypertensive drug use, hospitalisation and medication used to treat congestive heart failure. Eighteen percent of patients presented >1 new prescription for a nonselective NSAID during the study year. All adverse effects studied were more common in patients filling prescriptions for nonselective NSAID than in those not (control group). Average annual costs for the adverse effects studied were $1,234 (US dollars) in nonselective NSAID users compared with $1,036 for controls.After adjusting for socio-demographic factors, other health care utilisation, and relevant co-morbid diseases, the average annual cost for the major nonselective NSAID related adverse effects studied was $117 higher for patients presenting a nonselective NSAID prescription than for controls. Nonselective NSAID users with >4 risk factors for nonselective NSAID-related adverse effects had average excess costs of $316 over controls, whereas those with no risk factors had an average excess cost of only $75. The authors summarise that the excess cost of nonselective NSAID related adverse effects is modest in low-risk patients, but much higher in patients with specific risk factors. They comment that stratifying patients based on the risk of nonselective NSAID associated adverse effects can help clinicians and policymakers determine which patients might be the most appropriate for treatment options costlier than nonselective NSAIDs.ReferenceSolomon, D. Glynn, R. Bohn, R. et al. 2003. 'Hidden cost of nonselective nonsteroidal antiiflammatory drugs in older patients', Journal of Rheumatology, vol. 30, no. 4, pp. 792-798....