Abstract: The Hidden Cost of Nonselective Nonsteroidal Antiiflammatory Drugs in Older Patients

The Hidden Cost of Nonselective Nonsteroidal Antiiflammatory Drugs in Older Patients

DANIEL H. SOLOMON, ROBERT J. GLYNN, RHONDA BOHN, RAISA LEVIN, and JERRY AVORN

ABSTRACT.

Objective. Nonselective nonsteroidal antiinflammatory drugs (NSAID) are well known to cause an increased risk of gastrointestinal (GI) hemorrhage, congestive heart failure, and hypertension, but the cost of such adverse effects has not been rigorously defined. We calculated the excess risk and costs associated with the major adverse effects of prescription nonselective NSAID.

Methods. This study involved a retrospectively collected random cohort of 41,826 continuously enrolled patients over 65 years old in the New Jersey Pharmaceutical Assistance to the Aged and Disabled or Medicaid programs. We calculated the adjusted rates and costs of major adverse effects associated with nonselective NSAID, including hospitalization for GI hemorrhage, gastroprotective drug use, ambulatory upper GI procedures, antihypertensive drug use, and hospitalization and medication use to treat congestive heart failure.

Results. Eighteen percent of patients filled ³ 1 new prescription for a nonselective NSAID during the study year. All adverse effects studied were more common in patients filling prescriptions for nonselective NSAID than in those not. Average annual costs for the adverse effects studied were $1,234 (1998 US dollars) in nonselective NSAID users compared with $1,036 for controls. After adjusting for sociodemographic factors, other health care utilization, and relevant comorbid diseases, the average annual cost for the major nonselective NSAID related adverse effects studied was $117 higher for patients filling a nonselective NSAID prescription than for those who did not. Nonselective NSAID users with ³ 4 risk factors for nonselective NSAID related adverse effects had average excess costs of $316 over controls, whereas those with no risk factors had an average excess cost of only $75.

Conclusion. The excess cost of nonselective NSAID related adverse effects is modest in low risk patients, but much higher in patients with specific risk factors. This approach of stratifying patients based on the risk of nonselective NSAID associated adverse effects can help clinicians and policymakers determine which patients might be the most appropriate candidates for treatment options costlier than nonselective NSAID. (J Rheumatol 2003;30:792-8)

Key Indexing Terms:

NONSTEROIDAL ANTIINFLAMMATORY DRUGS
COST OF CARE
ADVERSE EFFECTS
GASTROINTESTINAL HEMORRHAGE
HYPERTENSION
CONGESTIVE HEART FAILURE

From the Division of Pharmacoepidemiology and Pharmacoeconomics; and Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Supported by K23 AR48616 (DHS). Dr. Solomon holds a Clinical Science Grant from the Arthritis Foundation.

D.H. Solomon, MD, MPH, Division of Pharmacoepidemiology and Pharmacoeconomics, and Division of Rheumatology, Immunology, and Allergy; R.J. Glynn, PhD, ScD; R. Bohn, DrPH; R. Levin, MS; J. Avorn, MD, Division of Rheumatology, Immunology, and Allergy.

Address reprint requests to Dr. D.H. Solomon, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, 221 Longwood Avenue, Suite 341, Boston, MA 02115. E-mail: dhsolomon@partners.org

Submitted March 25, 2002; revision accepted October 7, 2002.