Drugs & Aging

, Volume 24, Issue 8, pp 681–690

Direct Medical Costs of Serious Gastrointestinal Ulcers among Users of NSAIDs

  • Harald E. Vonkeman
  • Rogier M. Klok
  • Maarten J. Postma
  • Jacobus R. B. J. Brouwers
  • Mart A. F. J. van de Laar
Original Research Article



The occurrence and prevention of gastrointestinal ulcers during use of NSAIDs has become a major healthcare issue.


To determine the direct medical costs of serious NSAID-related ulcer complications.


An observational cost-of-illness study was conducted in a large general hospital serving a population of 152 989 persons. From November 2001 to December 2003 all consecutive patients hospitalised with serious NSAID-related ulcer complications were identified. Serious NSAID-related ulcer complications were defined as ulcerations of the stomach or proximal duodenum causing perforation, obstruction or bleeding that occurred during the use of NSAIDs, necessitating hospitalisation of the patient. Data were retrieved with respect to days hospitalised and the number and type of diagnostic and therapeutic interventions. The main outcome measure was estimated mean direct medical costs of resources used.


A total of 104 patients were hospitalised with serious NSAID-related ulcer complications (incidence 31.4 per 100 000 persons per year). Most patients were elderly (mean 70.4 years, SD 16.7). In-hospital mortality was 10.6%. Mean direct medical costs were €8375 (95% CI 7067, 10 393). On the basis of these results, we estimated that approximately 5105 people are hospitalised with serious NSAID-related ulcer complications in The Netherlands each year, of whom 541 die in hospital. The total annual direct medical costs for serious NSAID-related ulcer complications in The Netherlands were estimated to be €42 754 375 (95% CI 36 077 035, 53 056 265).


Serious NSAID-related ulcer complications have a mortality rate of 10.6% in The Netherlands and the annual direct medical costs to the country of such complications are approximately €42 750 000.


  1. 1.
    Verstappen SMM, Verkleij H, Bijlsma JWJ, et al. Determinants of direct costs in Dutch rheumatoid arthritis patients. Ann Rheum Dis 2004; 63: 817–24PubMedCrossRefGoogle Scholar
  2. 2.
    Bombardier C, Laine L, Reicin A, et al. Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis: VIGOR Study Group. N Engl J Med 2000; 343: 1520–8PubMedCrossRefGoogle Scholar
  3. 3.
    Silverstein FE, Faich G, Goldstein JL, et al. Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis. The CLASS study: a randomized controlled trial. Celecoxib Long-term Arthritis Safety Study. JAMA 2000; 284: 1247–55PubMedCrossRefGoogle Scholar
  4. 4.
    Rostom A, Dube C, Wells G, et al. Prevention of NSAID-induced gastroduodenal ulcers. Cochrane Database Syst Rev 2002; (4): CD002296Google Scholar
  5. 5.
    de Leest HTJI, van Dieten HEM, van Tulder MW, et al. Costs of treating bleeding and perforated peptic ulcers in The Netherlands. J Rheumatol 2004; 31: 788–91PubMedGoogle Scholar
  6. 6.
    Chevat C, Pena BM, Al MJ, et al. Healthcare resource utilisation and costs of treating NSAID-associated gastrointestinal toxicity: a multinational perspective. Pharmacoeconomics 2001; 19Suppl. 1: 17–32PubMedCrossRefGoogle Scholar
  7. 7.
    Herings RMC, Klungel OH. An epidemiological approach to assess the economic burden of NSAID-induced gastrointestinal events in The Netherlands. Pharmacoeconomics 2001; 19(6): 655–65PubMedCrossRefGoogle Scholar
  8. 8.
    National Center for Health Statistics. Classifications of diseases and functioning & disability [online]. Available from URL: http://www.cdc.gov/nchs/icd9.htm [Accessed 2007 Jul 1]
  9. 9.
    Oosterbrink JB, Bouwmans CAM, Koopmanschap MA, et al. Guideline for cost-of-illness study: methods and guideline-rates for economic evaluations in health-care (in Dutch). Diemen: College voor Zorgverzekeringen, 2004Google Scholar
  10. 10.
    Tariff book medical specialists. Utrecht: College Tarieven Gezondheidszorg, 1999Google Scholar
  11. 11.
    Tariff list hospitals. Utrecht: College Tarieven Gezondheidszorg, 1999Google Scholar
  12. 12.
    CBS; Statistics Netherlands. Population dynamics by birth, death and migration per region [online]. Available from URL: http://statline.cbs.nl [Accessed 2007 Jul 1]
  13. 13.
    Efron B, Tibshirani R. Bootstrap methods for standard errors, confidence intervals, and other measures of statistical accuracy. Stat Sci 1986; 1: 54–77CrossRefGoogle Scholar
  14. 14.
    Briggs AW, Wonderling DE, Mooney CZ. Pulling cost-effectiveness analysis up by its bootstraps: a non-parametric approach to confidence interval estimation. Health Econ 1997; 6: 327–40PubMedCrossRefGoogle Scholar
  15. 15.
    Sheldon T. Dutch doctors call for action on drug safety. BMJ 2006; 333: 1238PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2007

Authors and Affiliations

  • Harald E. Vonkeman
    • 1
  • Rogier M. Klok
    • 2
  • Maarten J. Postma
    • 2
  • Jacobus R. B. J. Brouwers
    • 2
  • Mart A. F. J. van de Laar
    • 1
  1. 1.Department of Rheumatology and Clinical ImmunologyMedisch Spectrum Twente Hospital, and University of TwenteEnschedeThe Netherlands
  2. 2.Groningen University Institute for Drug Exploration (GUIDE), Department of Social Pharmacy, Pharmacoepidemiology and PharmacotherapyGroningen UniversityGroningenThe Netherlands
  3. 3.Department of Rheumatology and Clinical ImmunologyMedisch Spectrum TwenteEnschedeThe Netherlands

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