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Pharmacy World and Science

, Volume 28, Issue 5, pp 309–317 | Cite as

Use and costs of anti-secretory and cardiovascular co-medication in osteoarthritis patients treated with selective or non-selective NSAIDS

  • Steven SimoensEmail author
  • Sandra De Coster
  • Bernard De Ruyck
  • Petra Stutz
  • Gert Laekeman
Original Paper

Abstract

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.

Method

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.

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 € 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.

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.

Keywords

Anti-secretory drugs Belgium Cardiovascular drugs Drug costs Non-selective NSAIDs Osteoarthritis Pharmacoeconomics Selective NSAIDs 

Notes

Acknowledgements

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.

References

  1. 1.
    Hernandez-Diaz S, Garcia Rodriguez LA. Association between nonsteroidal anti-inflammatory drugs and upper gastrointestinal tract bleeding/perforation: an overview of epidemiologic studies published in the 1990s. Arch Intern Med 2000;160:2093–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs. N Engl J Med 1999;340:1888–99.PubMedCrossRefGoogle Scholar
  3. 3.
    Bombardier C, Laine L, Reicin A, Shapiro D, Burgos-Vargas R, Davis B, et al. Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. New Engl J Med 2000;343:1520–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Silverstein F, Faich G, Goldstein JL, Simon LS, Pincus T, Whelton A, 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. J Am Med Assoc 2000;284:1247–55.CrossRefGoogle Scholar
  5. 5.
    Deeks JJ, Smith LA, Bradley MD. Efficacy, tolerability, and upper gastrointestinal safety of celecoxib for treatment of osteoarthritis and rheumatoid arthritis: systematic review of randomized controlled trials. Br Med J 2002;325:619.CrossRefGoogle Scholar
  6. 6.
    Moore RA, Derry S, Makinson GT, McQuay HJ. Tolerability and adverse events in clinical trials of celecoxib in osteoarthritis and rheumatoid arthritis: systematic review and meta-analysis of information from company clinical trial reports. Arthritis Res Ther 2005;7:R644–65.PubMedCrossRefGoogle Scholar
  7. 7.
    Caldwell B, Aldington S, Weatherall M, Shirtcliffe P, Beasley R. Risk of cardiovascular events and celecoxib: a systematic review and meta-analysis. J R Soc Med 2006;99:132–40.PubMedCrossRefGoogle Scholar
  8. 8.
    Vonkeman HE, Brouwers JRBJ, van de Laar MAFJ. Understanding the NSAID related risk of vascular events. Br Med J 2006;332:895–8.CrossRefGoogle Scholar
  9. 9.
    Konstantinopoulos PA, Lehmann DF. The cardiovascular toxicity of selective and nonselective cyclooxygenase inhibitors: comparisons, contrasts, and aspirin confounding. J Clin Pharmacol 2005;45:742–50.PubMedCrossRefGoogle Scholar
  10. 10.
    Jüni P, Nartey L, Reichenbach S, Sterchi R, Dieppe PA, Egger M. Risk of cardiovascular events and rofecoxib: cumulative meta-analysis. Lancet 2004;364:2021–9.PubMedCrossRefGoogle Scholar
  11. 11.
    European Medicines Agency. European Medicines Agency announces regulatory action on COX-2 inhibitors. http://www.emea.eu.int (10 May 2006).
  12. 12.
    Lanes SF, Lanza LL, Radensky PW, Yood RA, Meenan RF, Walker AM, et al. Resource utilization and cost of care for rheumatoid arthritis in a managed care setting. The importance of drug and surgery costs. Arthritis Rheum 1997;40:1475–81.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • Steven Simoens
    • 1
    Email author
  • Sandra De Coster
    • 1
  • Bernard De Ruyck
    • 2
  • Petra Stutz
    • 2
  • Gert Laekeman
    • 1
  1. 1.Research Centre for Pharmaceutical Care and Pharmaco-economics, Faculty of Pharmaceutical SciencesKatholieke Universiteit LeuvenLeuvenBelgium
  2. 2.Royal Pharmaceutical Society of AntwerpAntwerpenBelgium

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