Economic and gastrointestinal safety comparisons of etodolac, nabumetone, and oxaprozin from insurance claims data from patients with arthritis

This study was conducted to compare the effect of etodolac, nabumetone, and oxaprozin use on gastrointestinal (GI) safety and associated costs based o n insurance claims information from practice settings. Data were obtained f rom a national claims database (MarketScan(R)) for the years 1992 to 1994. The claims data of interest were for patients with arthritis who had used e todolac, nabumetone, or oxaprozin exclusively during a 9-month follow-up pe riod (ONLY groups), or these drugs plus (PLUS groups) the other nonsteroida l anti-inflammatory drugs (NSAIDs) ibuprofen, naproxen, diclofenac, sulinda c, piroxicam, ketoprofen, or indomethacin. For each group, we obtained info rmation on the use of inpatient and outpatient services for GI-related even ts and the associated costs. All GI admissions were classified as NSAID-ind uced or possibly NSAID-induced events based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) codes. All o utpatient upper GI ulcers or bleeding episodes were also identified by spec ific ICD-9 CM code. There were no significant between-group demographic dif ferences. The proportions of patients with NSAID-induced and possibly NSAID -induced GI admissions were 0.1% and 0.4% for the etodolac-ONLY, 0.3% and 1 .0% for the nabumetone-ONLY and 0.1% and 0.5% for the oxaprozin-ONLY groups , respectively (P > 0.05), and a similar pattern was observed among the PLU S groups. In outpatient settings, 3.9%, 4.2%, and 4.9% of the etodolac-, na bumetone-, and oxaprozin-ONLY patients, respectively (P > 0.05), and 6.0%, 5.3%, and 4.7% of the etodolac-, nabumetone-, and oxaprozin-PLUS patients, respectively, had at least one upper GI ulcer/bleeding claim (P > 0.05). Th e total health care costs for 9 months were approximately $3000 each for th e etodolac-, nabumetone-, and oxaprozin-ONLY groups. Oxaprozin, nabumetone, and etodolac had similar GI-safety and associated-costs profiles based on information from practice settings. Also, in patients who used multiple NSA IDs, the groups did not differ in their GI-safety and cost profiles.