title: The hidden cost of nonselective nonsteroidal antiinflammatory drugs in older patients.
abstract: OBJECTIVE
  Nonselective nonsteroidal antiinflammatory drugs (NSAID) are well known to cause an increased risk of gastrointestinal (GI) hemorrhage, congestive heart failure, and hypertension, but the cost of such adverse effects has not been rigorously defined. We calculated the excess risk and costs associated with the major adverse effects of prescription nonselective NSAID.
  
  
  METHODS
  This study involved a retrospectively collected random cohort of 41,826 continuously enrolled patients over 65 years old in the New Jersey Pharmaceutical Assistance to the Aged and Disabled or Medicaid programs. We calculated the adjusted rates and costs of major adverse effects associated with nonselective NSAID, including hospitalization for GI hemorrhage, gastroprotective drug use, ambulatory upper GI procedures, antihypertensive drug use, and hospitalization and medication use to treat congestive heart failure.
  
  
  RESULTS
  Eighteen percent of patients filled > or = 1 new prescription for a nonselective NSAID during the study year. All adverse effects studied were more common in patients filling prescriptions for nonselective NSAID than in those not. Average annual costs for the adverse effects studied were 1,234 (1998 US dollars) in nonselective NSAID users compared with 1,036 (1998 US dollars) for controls. After adjusting for sociodemographic factors, other health care utilization, and relevant comorbid diseases, the average annual cost for the major nonselective NSAID related adverse effects studied was 117 (1998 US dollars) higher for patients filling a nonselective NSAID prescription than for those who did not. Nonselective NSAID users with > or = 4 risk factors for nonselective NSAID related adverse effects had average excess costs of 316 (1998 US dollars) over controls, whereas those with no risk factors had an average excess cost of only 75 (1998 US dollars) .
  
  
  CONCLUSIONS
  The excess cost of nonselective NSAID related adverse effects is modest in low risk patients, but much higher in patients with specific risk factors. This approach of stratifying patients based on the risk of nonselective NSAID associated adverse effects can help clinicians and policymakers determine which patients might be the most appropriate candidates for treatment options costlier than nonselective NSAID.
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. dhsolomon@partners.org
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Glynn
authors.forename: Rhonda
authors.initials: R
authors.lastname: Bohn
authors.forename: Raisa
authors.initials: R
authors.lastname: Levin
authors.forename: Jerry
authors.initials: J
authors.lastname: Avorn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000191:economics*; D015331:Cohort Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D017048:Health Care Costs; D006333:Heart Failure / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000139:chemically induced* / Q000453:epidemiology; D008297:Male; D010818:Practice Patterns, Physicians'; D011897:Random Allocation; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal