title: Assessing physician choice of nonsteroidal antiinflammatory drugs in a health maintenance organization.
abstract: OBJECTIVE
  To develop a categorization scheme for grouping various nonsteroidal antiinflammatory drugs (NSAIDs) by relative safety; to develop a method to quantify the appropriateness of the initial and subsequent choices of NSAID therapy; to assess whether NSAID prescribing was consistent with the developed criteria; to examine the cost of inappropriate, acute NSAID use as defined by the established criteria.
  
  
  METHODS
  Retrospective drug utilization review focusing on NSAIDs.
  
  
  METHODS
  Members aged > or = 18 years of a 40,000-person southeastern Michigan health maintenance organization.
  
  
  METHODS
  (1) Appropriateness of therapy using a four-level safety classification system for the NSAIDs developed by a consensus process; criteria based on safety under the assumption that any particular NSAID is equally likely to be effective when dosed appropriately; (2) evaluation of progression of NSAID therapy using the NSAID Therapy Progression Formula.
  
  
  RESULTS
  For acute patients, almost half of the prescriptions were for ibuprofen and 33 percent were for naproxen. Ibuprofen usage accounted for 16 percent of total NSAID cost and naproxen agents accounted for over 50 percent of that cost. Potential cost savings of approximately $82,000 probably would have occurred had a 50 percent interchange rate for ibuprofen been acceptable. For chronic patients, 85 percent were treated with one or two NSAIDs; treatments were of reasonable high quality when compared by safety profiles. There was low use of ibuprofen in patients who only received one NSAID.
  
  
  CONCLUSIONS
  NSAID usage assessment in a large population was achieved by developing a classification and scoring system based on NSAID safety; in this population, prescribing patterns were generally consistent with established criteria; however, when considering cost, improvement in initial NSAID selection for acute patients was possible.
authors.affiliation: College of Pharmacy, University of Michigan, Ann Arbor.
authors.forename: B
authors.initials: B
authors.lastname: Kaplan
authors.forename: K B
authors.initials: KB
authors.lastname: Farris
authors.forename: D M
authors.initials: DM
authors.lastname: Kirking
mesh_terms: D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000145:classification / Q000191:economics / Q000627:therapeutic use*; D017723:Drug Utilization Review; D006279:Health Maintenance Organizations / Q000191:economics / Q000592:standards*; D006801:Humans; D007052:Ibuprofen / Q000191:economics; D008824:Michigan; D008875:Middle Aged; D009288:Naproxen / Q000191:economics; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D009288:Naproxen; D007052:Ibuprofen