An Epidemiological Approach to Assess the Economic Burden of NSAID-Induced Gastrointestinal Events in The Netherlands (original) (raw)

Abstract

Objective: To use the population attributable risk (PAR) to estimate the treatment costs resulting from non-steroidal anti-inflammatory drug (NSAID)—induced gastrointestinal (GI) morbidity.

Design: Two case-control studies with the following outcomes: (i) the start of therapy with gastroprotective agents (GPAs) and (ii) hospitalisations for GI events.

Setting: Community-dwelling inhabitants of defined areas in The Netherlands covering the period 1989 to 1998. All analyses were performed from the perspective of a third-party payer.

Methods: Risk and exposure data were obtained from the Dutch PHARMO system, a population-based register of drug-dispensing records and hospital records. The PAR was estimated based on stratum-specific prevalence estimates of NSAID use and the corresponding odds ratios (ORs) obtained from the case-control studies. Cost data were obtained from Dutch national hospital discharge records and tariffs. Annual treatment costs of NSAID-induced GI events were calculated based on the PAR in the sample population and extrapolated to the total population using national demographic data.

Results: The adjusted ORs for starting GPA use and hospitalisation for GI events were 6.6 [95% confidence interval (CI): 5.5 to 7.8] and 5.0 (95% CI: 4.0 to 6.2), respectively, in NSAID users compared with controls. Variation of OR with age among NSAID users suggested that prevention of GI events is most efficient among the elderly. The total annual cost (1998 values) of GPA use and hospitalisations for GI events attributable to the use of NSAIDs was 59 million euro (EUR) [95% CI: EUR38.5 million to EUR98 million]. More than 65% of these NSAID-induced costs, EUR38 million, can be attributed to long term users of NSAIDs, representing only 9.3% of all users of NSAIDs.

Conclusions: The PAR can be used to estimate the costs of drug-induced morbidity and changes in costs resulting from substitutions with other drugs. For each EUR1.00 spent on NSAIDs, an additional EUR0.68 (excluding costs for prophylactic treatment) can be added for the treatment of GI adverse events.

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References

  1. White TJ, Arakelian A, Rho JP. Counting the costs of drug related adverse events. Pharmacoeconomics 1999; 15: 445–58
    Article PubMed CAS Google Scholar
  2. Champion G, Feng PH, Azuma T, et al. NSAID-induced gastrointestinal damage: epidemiology, risk and prevention with an evaluation of the role of misoprostol: an Asian-Pacific perspective and consensus. Drugs 1997; 53: 6–19
    Article PubMed CAS Google Scholar
  3. Singh G, Ramey DR, Morfeld D, et al. Gastrointestinal tract complications of non-steroidal anti-inflammatory drug treatment in rheumatoid arthritis: a prospective observational cohort study. Arch Intern Med 1996; 156: 1530–6
    Article PubMed CAS Google Scholar
  4. Moore RA, Phillips CJ. Cost of NSAID adverse effects to the UK national Health Service. J Med Econ 1999; 2: 45–55
    Article Google Scholar
  5. Rothman K, Greenland S. Modern epidemiology. 2nd ed. Philadelphia (PA): Lippincot-Raven, 1998
    Google Scholar
  6. Rahme E, Lawrence J, Kong S, et al. Gastrointestinal health care resource use and costs associated with non-steroidal anti-inflammatory drugs versus acetaminophen: retrospective cohort study of an elderly population. ArthritisRheum2000; 43: 917–24
  7. Mietinnen OS. Theoretical epidemiology. Montreal: John Wiley & Sons Inc., 1985
    Google Scholar
  8. Coughlin SS, Benichou J, Weed DL. Attributable risk estimation in case controls studies. Epidemiol Rev 1994; 16: 51–64
    PubMed CAS Google Scholar
  9. Herings RM, Stricker BH, de Boer A, et al. Benzodiazepines and the risk of falling leading to femur fractures: dosage more important than elimination half-life. Arch Intern Med 1995; 155: 1801–7
    Article PubMed CAS Google Scholar
  10. McDonald TM, Morant SV, Robinson GC, et al. Association of upper gastrointestinal toxicity of non-steroidal anti-inflammatory drugs with continued exposure: cohort study. BMJ 1997; 315: 1333–7
    Article Google Scholar
  11. Herings R. PHARMO: a record linkage system for postmarketing surveillance of prescription drugs in The Netherlands. Utrecht: Department of Pharmaco-epidemiology & Pharmacotherapy, Utrecht University, 1993: 209
    Google Scholar
  12. Herings RMC, Panneman MJM, de Graag EJ. Farmacotherapie in beweging. Utrecht: PHARMO Institute, 2000
    Google Scholar
  13. Garcia Rodriguez L, Jick H. Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs. Lancet 1994; 343: 769–72
    Article PubMed CAS Google Scholar
  14. Gabriel SE, Jaakkimainen L, Bombardier C. Risk of serious gastrointestinal complications related to the use of nonsteroidal anti-inflammatory drugs: a meta analysis. Ann Intern Med 1991; 115: 787–96
    PubMed CAS Google Scholar
  15. Hallas J, Lauritsen J, Villadsen HD, et al. Nonsteroidal anti-inflammatory drugs and upper gastrointestinal bleeding, identifying high-risk groups by excess risk estimates. Scand J Gastroenterol 1995; 30: 438–44
    Article PubMed CAS Google Scholar
  16. Lanza LL, Walker AM, Bortnichak RA. Peptic ulcer and gastrointestinal haemorrhage associated with nonsteroidal anti-inflammatory drug use in patients younger than 65 years of age. Arch Intern Med 1995; 155: 1371–7
    Article PubMed CAS Google Scholar
  17. Ziekenfondsraad CMPCvd. Farmaceutisch Kompas. Amstelveen: Ziekenfondsraad, 1999
    Google Scholar
  18. Zorgverzekeraars CVZ. GIPeilingen/Kengetallen 1991–1998. Amstelveen, 1999
    Google Scholar
  19. Von Korff M, Wagner EH, Saunders K. A chronic disease score from automated pharmacy data. J Clin Epidemiol 1992; 45: 197–203
    Article Google Scholar
  20. Anonymous. EGRET manual. Seattle (WA): Statistic and Epidemiology Research Corporation, 1998
    Google Scholar
  21. Greenland S. Modelling and variable selection in epidemiologic analysis. Am J Public Health 1989; 79: 340–8
    Article PubMed CAS Google Scholar
  22. Polder JJ, Meerding WJ, Koopmanschap MA, et al. Kosten van ziekten in Nederland 1994. Rotterdam: Instituut voor Maatschappelijke Gezondheidszorg, 1997
    Google Scholar
  23. Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs. N Engl J Med 1999; 340: 1888–99
    Article PubMed CAS Google Scholar

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Acknowledgements

We thank Martien Panneman, and the pharmacists and hospitals who contribute to the PHARMO system for their cooperation. This work was supported by grants from Searle-Monsanto, Maarsen, The Netherlands, and MSD, Haarlem, The Netherlands.

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Authors and Affiliations

  1. PHARMO Institute, PO Box 82222, 3508TB, Utrecht, The Netherlands
    Ronald M. C. Herings
  2. Department of Pharmaco-epidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
    Ronald M. C. Herings & Olaf H. Klungel

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  1. Ronald M. C. Herings
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  2. Olaf H. Klungel
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Correspondence to Ronald M. C. Herings.

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Herings, R.M.C., Klungel, O.H. An Epidemiological Approach to Assess the Economic Burden of NSAID-Induced Gastrointestinal Events in The Netherlands.Pharmacoeconomics 19, 655–665 (2001). https://doi.org/10.2165/00019053-200119060-00004

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