Deviations from evidence-based prescribing of non-steroidal anti-inflammatory drugs in three European regions.
OBJECTIVE
We examined to what extent the evidence of the relative gastrointestinal toxicity with non-steroidal anti-inflammatory drugs (NSAIDs) was implemented in clinical practice in Bologna, Italy, Funen, Denmark, and Stockholm, Sweden, areas with accurate computerised information on prescriptions purchased by defined populations.


METHODS
We ranked each NSAID by purchased volume in defined daily doses during September 1996 and compared it with the ranking of gastrointestinal complications from a meta-analysis of controlled epidemiological studies published between 1986 and 1994. We restricted our comparison to those NSAIDs that accounted for 90% of the use and within this DU90% segment we determined the proportion of "high risk" (azapropazone, ketoprofen, piroxicam) and "low risk" (ibuprofen, diclofenac) drugs with respect to gastrointestinal toxicity.


RESULTS
In Funen, Denmark, we found the best NSAID profile (63% low risk/11% high risk) while Bologna, Italy, had the other extreme (26% low risk/38% high risk), with Stockholm, Sweden, in between (43% low risk/20% high risk).


CONCLUSIONS
Our study suggests that factors other than evidence-based medicine had a dominating impact on the use of prescription NSAIDs in 1996.
Bergman
U
U
Division of Clinical Pharmacology, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden. Ulf.Bergman@pharmlab.hs.sll.se
Andersen
M
M
Vaccheri
A
A
Bjerrum
L
L
Wettermark
B
B
Montanaro
N
N
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D003718:Denmark; D004363:Drug Utilization; D006801:Humans; D007558:Italy; D013548:Sweden
D000894:Anti-Inflammatory Agents, Non-Steroidal