Lanas A
Servicio de Aparato Digestivo, Hospital Clínico Universitario, Zaragoza.
Med Clin (Barc). 2000;114 Suppl 3:46-53.
Nonsteroidal anti-inflammatory drugs induce gastrointestinal side effects. In this study we have analyzed the economic impact of these side effects on the National Health System.
Costs were calculated based on actual data obtained from a General Hospital attending a population of 256,000 people with similar demographic distribution to the country 39 million people. The number of prescriptions of NSAID issued in the area during a 12 month period (1998), the attributable risks obtained from different epidemiological studies of this area and the rate and type of co-prescribing of gastroprotective agents were obtained from different local and national surveys and specialized agencies. Costs of complication and dyspepsia treatments were obtained from actual cost charged by the Spanish National Institute of Health. Sensitivity analyses were also performed to estimate maximal and minimum costs.
Costs per 100,000 people/year were: a) hospitalization = 24,100,983 pesetas; b) gastroprotective agents = 81,759,255 pesetas; c) management of dyspepsia = 31,527,895 pesetas. Estimates showed that global costs per 100,000 people/year were nor higher than 31,353 million and nor lower than 71,312 million pesetas. It was also estimated that gastroprotective therapy was inadequately prescribed in 80% of cases (25,720 million pesetas), and that 8,312 million pesetas per 100,000 patient/year of the global cost was due to OTC NSAID use. Globally, GI side effects increased 86% the actual cost of NSAID in 1998. Almost half of that increase was due to inadequate prescription of gastroprotective therapy and only 5.4% of that was due to OTC NSAID use.
Gastrointestinal side effects due to NSAID use have an enormous economic impact on the National Health System. Any new therapeutic strategy in the management of rheumatic conditions which decrease the rate of complications and the need of coprescription of gastroprotective agents will decrease these costs.
非甾体抗炎药会引发胃肠道副作用。在本研究中，我们分析了这些副作用对国家卫生系统的经济影响。
成本是根据从一家综合医院获取的实际数据计算得出的，该医院服务于25.6万人口，其人口统计学分布与该国3900万人口相似。从不同的地方和国家调查以及专业机构获取了该地区在12个月期间（1998年）开具的非甾体抗炎药处方数量、该地区不同流行病学研究得出的归因风险以及胃保护剂的联合处方率和类型。并发症和消化不良治疗的成本来自西班牙国家卫生研究所收取的实际费用。还进行了敏感性分析以估计最高和最低成本。
每10万人/年的成本为：a）住院治疗 = 24100983比塞塔；b）胃保护剂 = 81759255比塞塔；c）消化不良管理 = 31527895比塞塔。估计显示，每10万人/年的全球成本不高于313.53亿比塞塔，也不低于713.12亿比塞塔。还估计在80%的病例中（257.2亿比塞塔）胃保护疗法的处方不充分，并且每10万患者/年的全球成本中有83.12亿比塞塔归因于非处方非甾体抗炎药的使用。总体而言，1998年胃肠道副作用使非甾体抗炎药的实际成本增加了86%。几乎一半的增加归因于胃保护疗法的处方不充分，而只有5.4%归因于非处方非甾体抗炎药的使用。
非甾体抗炎药使用引起的胃肠道副作用对国家卫生系统具有巨大的经济影响。任何降低并发症发生率和减少胃保护剂联合处方需求的风湿性疾病管理新治疗策略都将降低这些成本。
