Cost-efficiency of nonsteroidal anti-inflammatory drug prescribing in Zagreb, Croatia.

The utilization and prescribing quality of non-steroidal anti-inflammatory drugs (NSAIDs) in Zagreb were assessed by calculating the number of defined daily doses (DDDs) from the number and size of packages of each prescription NSAID dispensed at 31 and 32 pharmacies during the years 2001 and 2002. NSAIDs accounting for 95% of overall NSAID utilization (DU95% segment) were analyzed. The proportion of NSAIDs associated with high (piroxicam), medium (diclofenac, naproxen, indometacin and ketoprofen) and low (ibuprofen) risk of gastrointestinal side effects, cost for each NSAID in DU95% segment, and cost per DDD were calculated. Four NSAIDs fell within DU95% segment: ibuprofen, diclofenac, ketoprofen and piroxicam. The cost for NSAIDs per DDD was by half lower within than beyond DU95% segment. Piroxicam was most expensive, and diclofenac and ketoprofen least expensive NSAIDs within DU95% in 2001 and 2002, respectively. The NSAID prescribing pattern was found to be in discrepancy with their relative gastrointestinal toxicity.