Gastrointestinal health care resource use and costs associated with nonsteroidal antiinflammatory drugs versus acetaminophen - Retrospective cohort study of an elderly population

Objective. To estimate gastrointestinal (GI) health care resource use and d irect costs associated with prescription nonsteroidal antiinflammatory drug s (NSAIDs) in an elderly population. Methods. Using the Government of Quebec's health insurance database, we obt ained the medical, pharmaceutical, and demographic records of 73,850 senior citizens who, between 1993 and 1997, had either an NSAID or an acetaminoph en prescription dispensed, The date of their first dispensed prescription f or an NSAID or acetaminophen was termed their index date. Patients who were not taking oral corticosteroids or anticoagulants at their index date, wer e not diagnosed with cancer at their index date, and were not hospitalized and did not have any GI events during the year prior to their index date we re included in the study. Patients who had a dispensed NSAID prescription a t their index date formed the NSAID cohort; the others formed the acetamino phen cohort. All patients were followed up for 2 years. The daily direct co sts of GI events incurred during NSAID therapy by the NSAID cohort were com pared with those incurred during a similar followup period by the acetamino phen cohort, The difference in these average daily costs was attributed to NSAID use. Results. The NSAID cohort included 5,268 senior citizens and the acetaminop hen cohort 2,245, More GI adverse events were observed in the NSAID cohort (odds ratio 2.48, 95% confidence interval 2.06, 3.00). The average daily di rect cost of GI events for a day of NSAID therapy attributed to the NSAIDs was $0.84 (Canadian), On average, for each Canadian dollar spent on NSAIDs, an additional $0.66 was spent on their side effects. Conclusion. Safer alternatives to NSAIDs would significantly reduce medical care costs for patients in need of NSAID therapy.