Deviations from evidence-based prescribing of non-steroidal anti-inflammatory drugs in three European regions

Objective: We examined to what extent the evidence of the relative gastroin testinal toxicity with non-steroidal anti-inflammatory drugs (NSAIDs) was i mplemented in clinical practice in Bologna, Italy, Funen, Denmark, and Stoc kholm, Sweden, areas with accurate computerised information on prescription s purchased by defined populations. Methods: We ranked each NSAID by purchased volume in defined daily doses du ring September 1996 and compared it with the ranking of gastrointestinal co mplications from a meta-analysis of controlled epidemiological studies publ ished between 1986 and 1994. We restricted our comparison to those NSAIDs t hat accounted for 90% of the use and within this DU90% segment we determine d the proportion of "high risk" (azapropazone, ketoprofen, piroxicam) and " low risk" (ibuprofen, diclofenac) drugs with respect to gastrointestinal to xicity. Results: In Funen, Denmark, we found the best NSAID profile (63% low risk/1 1% high risk) while Bologna, Italy, had the other extreme (26% low risk/38% high risk), with Stockholm, Sweden, in between (43% low risk/20% high risk ). Conclusion: Our study suggests that factors other than evidence-based medic ine had a dominating impact on the use of prescription NSAIDs in 1996.