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[Cost stratification of nonsteroidal anti-inflammatory drug-associated gastrointestinal side effects]
1Servicio de Aparato Digestivo, Hospital Clínico Universitario, Zaragoza. alanas@posta.unizar.es
Background:
Nonsteroidal anti-inflammatory drugs induce gastrointestinal side effects. In this study we have analyzed the economic impact of these side effects on the National Health System.
Material And Methods:
Costs were calculated based on actual data obtained from a General Hospital attending a population of 256,000 people with similar demographic distribution to the country 39 million people. The number of prescriptions of NSAID issued in the area during a 12 month period (1998), the attributable risks obtained from different epidemiological studies of this area and the rate and type of co-prescribing of gastroprotective agents were obtained from different local and national surveys and specialized agencies. Costs of complication and dyspepsia treatments were obtained from actual cost charged by the Spanish National Institute of Health. Sensitivity analyses were also performed to estimate maximal and minimum costs.
Results:
Costs per 100,000 people/year were: a) hospitalization = 24,100,983 pesetas; b) gastroprotective agents = 81,759,255 pesetas; c) management of dyspepsia = 31,527,895 pesetas. Estimates showed that global costs per 100,000 people/year were nor higher than 31,353 million and nor lower than 71,312 million pesetas. It was also estimated that gastroprotective therapy was inadequately prescribed in 80% of cases (25,720 million pesetas), and that 8,312 million pesetas per 100,000 patient/year of the global cost was due to OTC NSAID use. Globally, GI side effects increased 86% the actual cost of NSAID in 1998. Almost half of that increase was due to inadequate prescription of gastroprotective therapy and only 5.4% of that was due to OTC NSAID use.
Conclusions:
Gastrointestinal side effects due to NSAID use have an enormous economic impact on the National Health System. Any new therapeutic strategy in the management of rheumatic conditions which decrease the rate of complications and the need of coprescription of gastroprotective agents will decrease these costs.