老年患者中与非甾体抗炎药相关的胃肠道不良事件的成本。
Cost of prescribed NSAID-related gastrointestinal adverse events in elderly patients.
作者信息
Rahme E, Joseph L, Kong S X, Watson D J, LeLorier J
机构信息
Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada.
出版信息
Br J Clin Pharmacol. 2001 Aug;52(2):185-92. doi: 10.1046/j.1365-2125.2001.00348.x.
AIMS
It is well established that nonsteroidal anti-inflammatory drugs (NSAIDs) have gastrointestinal (GI) side-effects. However, the cost of health care resources spent on preventing and managing these side-effects is not clear. The objective of this study was to estimate the direct cost of NSAID-related GI events in an elderly population.
METHODS
From the Régie de l'assurance-maladie du Québec (RAMQ) database, we obtained medical, pharmaceutical and demographic records of a 10% random sample (n = 49 033) of seniors who, between January 1, 1993 and December 31, 1997, had a dispensed prescription of a NSAID. Patients who did not have any GI events during the year prior to their first dispensed prescription were included in the cohort. All patients were followed-up for 2 years. The daily direct Canadian dollar costs of GI events that were incurred by these patients while they were on NSAID therapy were compared with those of GI events that were incurred by these same patients while they were not on NSAID therapy. The difference in these daily costs was attributed to NSAIDs.
RESULTS
A total of 12 082 new NSAID users were included in the study. Two hundred and seventeen (1.8%) were hospitalized for GI-related problems; of these, 130 (60%) had their GI hospitalization as their first GI event; 3257 (27.0%) used gastroprotective agents (GPAs), and 857 (26.3%) took GPAs without any apparent prior GI symptoms; 801 (6.6%) had GI diagnostic tests; and 661 (5.5%) died. The average direct costs of GI side-effects per patient-day on NSAIDs were 3.5 times higher than those of a patient-day not on NSAIDs. The direct cost of GI side-effects per patient-day on NSAIDs was $1.34, of which more than 70% ($0.94) was attributed to GI events resulting from NSAID treatment.
CONCLUSIONS
Approximately one Canadian dollar was added to patient costs for every day he/she was on NSAID therapy. Safer therapies and appropriate patient risk management may potentially reduce NSAID-related health care resource use.
目的
非甾体抗炎药（NSAIDs）具有胃肠道（GI）副作用，这一点已得到充分证实。然而，用于预防和处理这些副作用的医疗保健资源成本尚不清楚。本研究的目的是估计老年人群中与NSAIDs相关的胃肠道事件的直接成本。
方法
从魁北克医疗保险局（RAMQ）数据库中，我们获取了1993年1月1日至1997年12月31日期间开具过NSAIDs处方的10%随机样本（n = 49033）老年人的医疗、药品和人口统计学记录。首次开具NSAIDs处方前一年未发生任何胃肠道事件的患者被纳入队列。所有患者随访2年。将这些患者在服用NSAIDs治疗期间发生胃肠道事件的每日直接加元成本与未服用NSAIDs治疗期间发生胃肠道事件的成本进行比较。这些每日成本的差异归因于NSAIDs。
结果
共有12082名新的NSAIDs使用者被纳入研究。217人（1.8%）因胃肠道相关问题住院；其中，130人（60%）首次胃肠道事件为胃肠道住院；3257人（27.0%）使用了胃保护剂（GPA），857人（26.3%）在无明显先前胃肠道症状的情况下服用了GPA；801人（6.6%）进行了胃肠道诊断检查；661人（5.5%）死亡。服用NSAIDs时每位患者每天胃肠道副作用的平均直接成本比未服用NSAIDs时高3.5倍。服用NSAIDs时每位患者每天胃肠道副作用的直接成本为1.34加元，其中超过70%（0.94加元）归因于NSAIDs治疗导致的胃肠道事件。
结论
患者服用NSAIDs治疗的每一天，其成本大约会增加1加元。更安全的治疗方法和适当的患者风险管理可能会减少与NSAIDs相关的医疗保健资源使用。
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