ANALYSIS OF THE COSTS OF NSAID-ASSOCIATED GASTROPATHY - EXPERIENCE INA US HEALTH MAINTENANCE ORGANIZATION

Clinicians recognise nonsteroidal anti-inflammatory drugs (NSAIDs) as valuable first-line agents in the treatment of rheumatic disorders and as dangerous irritants to the gastrointestinal tract. This has led to questions about the economic impact of NSAID-induced gastropathy in p opulations. This study estimated the 1992 costs of NSAID-associated ga stropathy episodes, and calculated an iatrogenic cast factor for NSAID -associated gastropathy among elderly members of a health maintenance organisation (HMO), the Northwest Region of Kaiser Permanente. Using d ata retrieved from automated databases and from medical records, NSAID and antiulcer drug costs were calculated, and estimates were made of the incidence rates of inpatient and outpatient NSAID-associated gastr opathies, the services provided to treat them, and the cost of those s ervices. Kaiser Permanente Northwest spent $US0.35 for each $US1.00 sp ent on NSAID therapy for the elderly, an iatrogenic cost factor of 1.3 5. The estimated average treatment per NSAID-associated gastropathy ep isode was $US2172. The average outpatient pharmacy cost per elderly NS AID user was $US80 and estimated average NSAID-associated treatment co st per elderly NSAID user was $US43. Although the findings were specif ic to the HMO because of the databases used, the methodology employed and the drug formulary influence on NSAID selection, they show that a substantial amount of resources were used to treat NSAID-induced gastr opathies in the elderly, underscoring the risk of prescribing NSAIDs a nd reinforcing the need for their prudent use in elderly patients.