CONCURRENT USE OF ANTIULCERATIVE AGENTS

Many physicians prescribe more than one antiulcerative agent (AUA) sim ultaneously to the same patient, although there is little evidence to support this practice. The purposes of this study were to (a) determin e patient factors associated with the concurrent use of these agents a nd (b) estimate the excess costs generated by the prescription of mult iple rather than a single agent. We conducted a case-control study of concurrent AUA users among New Jersey Medicaid enrollees age 65 years and older. To evaluate the excess cost generated by the ongoing prescr iption of an additional AUA, we measured the additional drug expenditu res associated with each regimen of concurrent use. Nearly 1 in 15 AUA users (6.6%) met our conservative definition of concurrent AUA use. I n a multiple logistic regression model, previous gastrointestinal proc edure, use of a non-steroidal anti-inflammatory drugs, nursing home re sidency, and recent hospitalization for more than 20 days were all pre dictors of concurrent use of more than one AUA. No association was fou nd with age, sex, or number of pharmacies used. The upper bound estima te of the cost generated by the concurrent prescription of a second AU A was $210 (range: $2-$942) over the 180-day study period, with a lowe r bound of $151 (range: $1-$449). Annually, such excess cost would ran ge from $301 to $420 per patient. This would account for between $457 million and $637 million per year for the nation's elderly if these pa tterns are generalizable. Despite the lack of evidence of therapeutic benefit from multiple concurrent AUA use in most patients, this practi ce is fairly common. Besides introducing the risk of additional costs and side effects in the absence of additional efficacy, the costs of s uch duplicative prescribing are substantial.