Sturkenboom Miriam C J M, Romano Ferdinando, Simon Giorgio, Correa-Leite Maria L, Villa Marco, Nicolosi Alfredo, Borgnolo Giulio, Bianchi-Porro Gabriele, Mannino Salvatore
Institute of Biomedical Technologies, National Research Council, Milan, Italy.
Arthritis Rheum. 2002 Apr 15;47(2):132-40. doi: 10.1002/art.10268.
To estimate the iatrogenic costs of nonsteroidal antiinflammatory drug (NSAID) treatment from the perspective of the Italian National Health Service.
We conducted a retrospective cohort study using the primary and secondary care claims data registered in the regional health service database in the Friuli-Venezia Giulia (Italy). The study cohort comprised all persons(265,114) who received at least one prescription for any NSAID between August 1996 and July 1998. The outcomes of interest were the costs of medical interventions for upper gastrointestinal disorders following NSAID treatment (i.e., prescriptions for gastroprotective drugs, hospitalizations, and outpatient diagnostic procedures).
The study population received a total of 660,311 NSAID prescriptions for a cost of 6,587,533 Euros (0.53 euro per treatment day). The cost of medical interventions for gastrointestinal events added 58% to the cost of NSAID therapy (0.31 euro per NSAID treatment day, up to 64% directly attributable to NSAID use). The iatrogenic costs were generated by 12.4% of the patients, 77% of whom had a positive history of gastrointestinal disorders and 82% of whom were older than 50 years. Co-prescriptions for gastroprotective drugs accounted for 78.6% of the overall iatrogenic costs. The iatrogenic costs did not differ between cyclooxygenase (COX) nonselective and COX-2 preferential drugs within strata of age and prior history of gastrointestinal disorders, but were significantly higher for the parenteral NSAIDs than the oral or rectal formulations.
In Italy, the iatrogenic costs of NSAID therapy add 58% to the cost of NSAID treatment; most of the cost is generated by co-prescriptions of gastroprotective drugs to elderly NSAID users or patients with a history of gastrointestinal disorders.
从意大利国家医疗服务体系的角度估算非甾体抗炎药（NSAID）治疗的医源性成本。
我们利用弗留利-威尼斯朱利亚大区（意大利）区域医疗服务数据库中登记的初级和二级医疗理赔数据进行了一项回顾性队列研究。研究队列包括1996年8月至1998年7月期间至少接受过一次任何NSAID处方的所有人员（265,114人）。感兴趣的结局是NSAID治疗后上消化道疾病的医疗干预成本（即胃保护药物的处方、住院治疗和门诊诊断程序）。
研究人群共收到660,311份NSAID处方，费用为6,587,533欧元（每次治疗日0.53欧元）。胃肠道事件的医疗干预成本使NSAID治疗成本增加了58%（每次NSAID治疗日0.31欧元，高达64%可直接归因于NSAID的使用）。医源性成本由12.4%的患者产生，其中77%有胃肠道疾病阳性史，82%年龄超过50岁。胃保护药物的联合处方占医源性总成本的78.6%。在年龄和胃肠道疾病既往史分层中，环氧化酶（COX）非选择性药物和COX-2选择性药物的医源性成本没有差异，但胃肠外NSAID的医源性成本显著高于口服或直肠制剂。
在意大利，NSAID治疗的医源性成本使NSAID治疗成本增加了58%；大部分成本是由给老年NSAID使用者或有胃肠道疾病史的患者联合开具胃保护药物产生的。
