Gastrointestinal-related healthcare resource usage associated with a fixedcombination of diclofenac and misoprostol versus other NSAIDs

Objective: To compare gastrointestinal (GI) healthcare resource use (HCRU) and associated costs in patients taking a fixed combination of diclofenac a nd misoprostol versus other nonsteroidal anti-inflammatory drugs (NSAIDs). Methods: We analysed a sample (49 033 patients) of the Government of Quebec Health Insurance Agency database. Patients were included in the study if t hey did not have GI events during the year preceding the date of their firs t NSAID prescription dispensing (the index date). Patients were followed up for 2 years. A 3-stage model was used to determine the factors that influe nced the direct medical costs of GI HCRU: (i) a logistic regression model ( model 1) to estimate the risk of GI HCRU; (ii) a linear regression model (m odel 2) to estimate the direct costs of GI HCRU for those who had such even ts; (iii) multiplying the estimated risks from model 1 by the estimated cos ts from model 2 gave the estimated direct costs of GI HCRU for all patients . Study Perspective: Provincial government of Quebec, Canada. Results: 1533 patients were prescribed diclofenac/misoprostol at the index date and 10 540 another NSAID. Comorbidity markers were not significantly d ifferent between the 2 groups. Of the diclofenac/misoprostol patients, 23 ( 1.5%) were hospitalised for GI problems compared with 194 (1.8%) of the NSA ID group; 403 (26.3%) of diclofenac/misoprostol patients used gastroprotect ive agents compared with 2849 (27.0%) of the NSAID patients; 118 (7.7%) of diclofenac/misoprostol patients had GI diagnostic tests compared with 682 ( 6.5%) of the NSAID patients. The average direct medical cost of GI HCRU was 310.52 Canadian dollars ($Can)/patient(1997 values) in the diclofenac/miso prostol group compared with $Can231.19/patient (1997 values) in the NSAID g roup. When adjusted for baseline factors, the ratio of the total direct med ical cost of GI HCRU in the diclofenac/misoprostol group to that of the NSA ID group was 1.15 (95% confidence interval: 0.89, 1.48). Conclusions: Our data showed no significant differences in GI HCRU among pa tients taking diclofenac/misoprostol compared with those taking NSAIDs.