title: Gastrointestinal health care resource use and costs associated with nonsteroidal antiinflammatory drugs versus acetaminophen: retrospective cohort study of an elderly population.
abstract: OBJECTIVE
  To estimate gastrointestinal (GI) health care resource use and direct costs associated with prescription nonsteroidal antiinflammatory drugs (NSAIDs) in an elderly population.
  
  
  METHODS
  Using the Government of Quebec's health insurance database, we obtained the medical, pharmaceutical, and demographic records of 73,850 senior citizens who, between 1993 and 1997, had either an NSAID or an acetaminophen prescription dispensed. The date of their first dispensed prescription for an NSAID or acetaminophen was termed their index date. Patients who were not taking oral corticosteroids or anticoagulants at their index date, were not diagnosed with cancer at their index date, and were not hospitalized and did not have any GI events during the year prior to their index date were included in the study. Patients who had a dispensed NSAID prescription at their index date formed the NSAID cohort; the others formed the acetaminophen cohort. All patients were followed up for 2 years. The daily direct costs of GI events incurred during NSAID therapy by the NSAID cohort were compared with those incurred during a similar followup period by the acetaminophen cohort. The difference in these average daily costs was attributed to NSAID use.
  
  
  RESULTS
  The NSAID cohort included 5,268 senior citizens and the acetaminophen cohort 2,245. More GI adverse events were observed in the NSAID cohort (odds ratio 2.48, 95% confidence interval 2.06, 3.00). The average daily direct cost of GI events for a day of NSAID therapy attributed to the NSAIDs was $0.84 (Canadian). On average, for each Canadian dollar spent on NSAIDs, an additional $0.66 was spent on their side effects.
  
  
  CONCLUSIONS
  Safer alternatives to NSAIDs would significantly reduce medical care costs for patients in need of NSAID therapy.
authors.affiliation: Centre Hospitalier de l'Université de Montréal-Hôtel-Dieu, Quebec, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Rahme
authors.forename: L
authors.initials: L
authors.lastname: Joseph
authors.forename: S X
authors.initials: SX
authors.lastname: Kong
authors.forename: D J
authors.initials: DJ
authors.lastname: Watson
authors.forename: J
authors.initials: J
authors.lastname: LeLorier
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects* / Q000191:economics* / Q000627:therapeutic use; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000191:economics* / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D002170:Canada; D015331:Cohort Studies; D003695:Delivery of Health Care; D005252:Fees, Pharmaceutical; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000139:chemically induced*; D006801:Humans; D016015:Logistic Models; D008297:Male; D016595:Misoprostol / Q000627:therapeutic use; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D016595:Misoprostol; D000082:Acetaminophen