title: Excess costs from gastrointestinal disease associated with nonsteroidal anti-inflammatory drugs.
abstract: OBJECTIVE
  To quantify medical care costs for the diagnosis and treatment of gastrointestinal disorders attributable to use of nonsteroidal anti-inflammatory drugs (NSAIDs) other than aspirin in elderly persons.
  
  
  METHODS
  Retrospective cohort study of 75,350 Tennessee Medicaid enrollees at least 65 years of age.
  
  
  METHODS
  The cohort was classified by baseline NSAID use as nonusers (no use preceding 1988), occasional users (< 75% of days) or regular users (> or = 75% of days). For the follow-up year (1989), we calculated annual rates of utilization of and Medicare/Medicaid payments for: medical care for NSAID-associated gastrointestinal disorders; hospitalizations/emergency department visits for peptic ulcers, gastritis/duodenitis, and gastrointestinal bleeding; outpatient upper and lower gastrointestinal tract radiologic and endoscopic examinations; and histamine2 (H2)-receptor antagonist, sucralfate, and antacid prescriptions. Rates were adjusted for demographic characteristics and baseline health care utilization.
  
  
  RESULTS
  Among nonusers of NSAIDs, the adjusted mean annual payment for all types of medical care for study gastrointestinal disorders was $134. This increased to $180 among occasional users, an excess of $46 (p < .001); and to $244 among regular users, an excess of $111 (p < .001, comparison with both nonusers and occasional users). Cohort members with any baseline year NSAID use had an adjusted mean annual payment of $191, $57 (p < .001) higher than that for nonusers. In both users and nonusers of NSAIDs, medications and inpatient care accounted for the largest component of costs. Among regular NSAID users, excess payments increased with baseline NSAID dose: $56, $120, and $157 for less than 1, 1 to 2, and more than 2 standard units per day, respectively (p < .01, linear trend).
  
  
  CONCLUSIONS
  Nonsteroidal anti-inflammatory drug (NSAID) use in elderly patients was associated with substantial excess costs and utilization of medical care for gastrointestinal disorders.
authors.affiliation: Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tenn, USA.
authors.forename: W E
authors.initials: WE
authors.lastname: Smalley
authors.forename: M R
authors.initials: MR
authors.lastname: Griffin
authors.forename: R L
authors.initials: RL
authors.lastname: Fought
authors.forename: W A
authors.initials: WA
authors.lastname: Ray
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000191:economics* / Q000627:therapeutic use; D015331:Cohort Studies; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D005260:Female; D005767:Gastrointestinal Diseases / Q000188:drug therapy / Q000191:economics; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics*; D006278:Medicare / Q000191:economics*; D015999:Multivariate Analysis; D012189:Retrospective Studies; D014481:United States
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal