Use and costs of anti-secretory and cardiovascular co-medication in osteoarthritis patients treated with selective or non-selective NSAIDS.
OBJECTIVE
This study aims to compare use and costs of anti-secretory and cardiovascular co-medication in osteoarthritis patients treated with selective or non-selective NSAIDs.


METHODS
A retrospective study examined Belgian patients aged 65 years or more who suffer from osteoarthritis and are chronic users of selective NSAIDs (n=1,376) or non-selective NSAIDs (n=8,482). A before-and-after analysis compared drug use and costs between period 1 (first 6 months of 2002) and period 2 (several 1-year periods stretching over 2003-2004). A cohort analysis contrasted patients taking selective NSAIDs with patients taking non-selective NSAIDs.


METHODS
Anti-secretory co-medication included histamine H2-receptor antagonists and proton pump inhibitors. Cardiovascular co-medication referred to cardiac glycosides, anti-arrhythmics, anti-thrombotics, anti-angina drugs, anti-hypertensive drugs and serum-lipid-reducing drugs. Volume of drug use was expressed as number of packages and costs were computed in Euro.


RESULTS
The volume of anti-secretory co-medication increased by 36% with selective NSAIDs and by 55% with non-selective NSAIDs between periods 1 and 2. Cardiovascular co-medication rose by 18% with selective NSAIDs and by 12% for non-selective NSAIDs. Focusing on patients who did not take anti-secretory co-medication in period 1, patients taking selective NSAIDs were just as likely to start anti-secretory co-medication in period 2 as patients taking non-selective NSAIDs (odds ratio: 1.05; 95% confidence interval: 0.90-1.23). Patients taking selective NSAIDs were just as likely to start cardiovascular co-medication as patients taking non-selective NSAIDs (odds ratio: 1.03; 95% confidence interval: 0.78-1.36). Annual costs of treating osteoarthritis in ambulatory care amounted to 756 <euro> with selective NSAIDs and 416 <euro> with non-selective NSAIDs. This originated from higher acquisition costs (278 <euro> vs. 24 <euro>) and higher costs of co-medication (477 <euro> vs. 392 <euro>) with selective NSAIDs.


CONCLUSIONS
The use of selective and non-selective NSAIDs is accompanied by a higher use of co-medication over time. The increase in anti-secretory co-medication was more prominent with non-selective NSAIDs. The rise in cardiovascular co-medication was more pronounced with selective NSAIDs. Treatment of osteoarthritis with selective NSAIDs is more expensive than with non-selective NSAIDs in terms of acquisition costs and costs of co-medication.
Simoens
Steven
S
Research Centre for Pharmaceutical Care and Pharmaco-economics, Faculty of Pharmaceutical Sciences, Katholieke Universiteit Leuven, Onderwijs en Navorsing 2, Herestraat 49, P.O. Box 521, 3000, Leuven, Belgium. steven.simoens@pharm.kuleuven.be
De Coster
Sandra
S
De Ruyck
Bernard
B
Stutz
Petra
P
Laekeman
Gert
G
D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D002317:Cardiovascular Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000150:complications* / Q000188:drug therapy* / Q000191:economics / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D010003:Osteoarthritis / Q000150:complications* / Q000188:drug therapy* / Q000191:economics / Q000473:pathology
D000894:Anti-Inflammatory Agents, Non-Steroidal; D002317:Cardiovascular Agents