Use and costs of anti-secretory and cardiovascular co-medication in osteoarthritis patients treated with selective or non-selective NSAIDS
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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.
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.
Main outcome measures
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.
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 € with selective NSAIDs and 416 € with non-selective NSAIDs. This originated from higher acquisition costs (278 € vs. 24 €) and higher costs of co-medication (477 € vs. 392 €) with selective NSAIDs.
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.
KeywordsAnti-secretory drugs Belgium Cardiovascular drugs Drug costs Non-selective NSAIDs Osteoarthritis Pharmacoeconomics Selective NSAIDs
The European Society of Clinical Pharmacy provided financial support for the data extraction. The authors would like to express their gratitude to participating community pharmacies, the Commission for the Protection of the Personal Environment, the Crossroad Bank and the Royal Pharmaceutical Society of Antwerp for permitting access to reimbursement data. We are also indebted to Kristien De Bruyn for providing data on reimbursement of NSAIDs in Belgium.
Conflicts of interest The authors have no conflicts of interest that are directly relevant to the content of this manuscript.
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