Phillips A C, Polisson R P, Simon L S
Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Drugs Aging. 1997 Feb;10(2):119-30. doi: 10.2165/00002512-199710020-00005.
Despite their propensity to cause toxicity, nonsteroidal anti-inflammatory drugs (NSAIDs) are routinely prescribed for older patients for painful musculoskeletal conditions, many of which are noninflammatory in nature. In some settings, simple analgesia with paracetamol (acetaminophen) or tramadol may be just as effective as NSAIDs. The benefits of therapy with NSAIDs must be weighed against their potential risks. With the anticipated growth of the elderly population, the economic implications of NSAID use in older patients are staggering. Estimates of the total cost of prescribing NSAIDs to the elderly must include the additional costs of gastroprotective agents, prophylaxis, laboratory monitoring, physician evaluations and interventions for adverse effects. Misoprostol may be cost effective as primary prophylaxis of NSAID-induced ulcer disease in some elderly patients. NSAIDs may reduce disability and improve quality of life, thereby offsetting their costs. To date, the direct, indirect and intangible cost of NSAIDs and cost offsets have not been systematically evaluated in the elderly. At this juncture, NSAIDs may be used judiciously in older patients, and misoprostol should be considered in high risk patients. Further studies to assess the economics of NSAIDs in the elderly population are warranted.
尽管非甾体抗炎药（NSAIDs）有导致毒性的倾向，但在老年患者中，它们仍被常规用于治疗疼痛性肌肉骨骼疾病，其中许多疾病本质上并非炎症性疾病。在某些情况下，使用对乙酰氨基酚或曲马多进行简单镇痛可能与使用NSAIDs一样有效。使用NSAIDs治疗的益处必须与其潜在风险相权衡。随着老年人口的预期增长，NSAIDs在老年患者中使用的经济影响惊人。给老年人开具NSAIDs的总成本估计必须包括胃保护剂、预防措施、实验室监测、医生评估以及不良反应干预的额外费用。在一些老年患者中，米索前列醇作为NSAIDs诱导的溃疡病的一级预防可能具有成本效益。NSAIDs可能会减少残疾并改善生活质量，从而抵消其成本。迄今为止，NSAIDs的直接、间接和无形成本以及成本抵消在老年人中尚未得到系统评估。在这个时候，NSAIDs可以在老年患者中谨慎使用，高危患者应考虑使用米索前列醇。有必要进行进一步的研究来评估NSAIDs在老年人群中的经济学情况。
