Cost of prescribed NSAID-related gastrointestinal adverse events in elderly patients

Aims It is well established that nonsteroidal anti-inflammatory drugs (NSAI Ds) have gastrointestinal (GI) side-effects. However, the cost of health ca re resources spent on preventing and managing these side-effects is not cle ar. The objective of this study was to estimate the direct cost of NSAID-re lated GI events in an elderly population. Methods From the Regie de l'assurance-maladie du Quebec (RAMQ) database, we obtained medical, pharmaceutical and demographic records of a 10% random s ample (n = 49 033) of seniors who, between January 1, 1993 and December 31, 1997, had a dispensed prescription of a NSAID. Patients who did not have a ny GI events during the year prior to their first dispensed prescription we re included in the cohort. All patients were followed-up for 2 years. The d aily direct Canadian dollar costs of GI events that were incurred by these patients while they were on NSAID therapy were compared with those of GI ev ents that were incurred by these same patients while they were not on NSAID therapy. The difference in these daily costs was attributed to NSAIDs. Results A total of 12 082 new NSAID users were included in the study. Two h undred and seventeen (1.8%) were hospitalized for GI-related problems; of t hese, 130 (60%) had their GI hospitalization as their first GI event; 3257 (27.0%) used gastroprotective agents (GPAs), and 857 (26.3%) took GPAs with out any apparent prior GI symptoms; 801 (6.6%) had GI diagnostic tests; and 661 (5.5%) died. The average direct costs of GI side-effects per patient-d ay on NSAIDs were 3.5 times higher than those of a patient-day not on NSAID s. The direct cost of GI side-effects per patient-day on NSAIDs was $1.34, of which more than 70% ($0.94) was attributed to GI events resulting from N SAID treatment. Conclusions Approximately one Canadian dollar was added to patient costs fo r every day he/she was on NSAID therapy. Safer therapies and appropriate pa tient risk management may potentially reduce NSAID-related health care reso urce use.