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Utilization of nonsteroidal anti-inflammatory drugs and antisecretory agents: a managed care claims analysis.
Am J Med. 2004 Jun 15; 116(12):835-42.AJ

Abstract

PURPOSE

To describe patients initiating nonsteroidal anti-inflammatory drug (NSAID) therapy with regard to gastrointestinal and cardiac risks and patterns of antisecretory agent use, and to explore the relation between therapy type and subsequent outcomes.

METHODS

We studied patients aged 18 years or older who had continuous coverage from 1998 to 2001 and who had initiated treatment with cyclooxygenase-2 (COX-2) selective inhibitors or nonselective NSAIDs. Patients were categorized with respect to gastrointestinal and cardiac risk profiles. Proton pump inhibitor use within 15 days of initiating NSAID therapy was considered prophylactic. Logistic regression analysis was used to evaluate associations between treatment and hospitalization events, cardiac events, and health care costs.

RESULTS

We identified 106,564 eligible NSAID initiators: 65.2% used COX-2 inhibitors and 34.8% used traditional NSAIDs. Users of COX-2 inhibitors were more likely to be at higher risk of gastrointestinal bleeding and cardiac events than were NSAID users. Proton pump inhibitor prophylaxis was most common among users of COX-2 inhibitors, but was only 11% in patients at high risk of gastrointestinal bleeding. There were no differences among treatment groups in terms of gastrointestinal or cardiac events. Initiation of COX-2 inhibitor therapy was associated with greater total health care costs.

CONCLUSION

Although we found that COX-2 inhibitors were used more frequently than were traditional NSAIDs in certain groups of patients with varying cardiac or gastrointestinal risk, we did not find that their use resulted in reductions in clinical events, cotherapy with proton pump inhibitors, or costs, suggesting that a better understanding of the relation between NSAID treatment strategies and outcomes in patients with differing risk characteristics is needed.

Authors+Show Affiliations

Department of Medicine, Zynx Health-A Cerner Company, Beverly Hills, California 90212, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15178499

Citation

Ofman, Joshua J., et al. "Utilization of Nonsteroidal Anti-inflammatory Drugs and Antisecretory Agents: a Managed Care Claims Analysis." The American Journal of Medicine, vol. 116, no. 12, 2004, pp. 835-42.
Ofman JJ, Badamgarav E, Henning JM, et al. Utilization of nonsteroidal anti-inflammatory drugs and antisecretory agents: a managed care claims analysis. Am J Med. 2004;116(12):835-42.
Ofman, J. J., Badamgarav, E., Henning, J. M., Knight, K., & Laine, L. (2004). Utilization of nonsteroidal anti-inflammatory drugs and antisecretory agents: a managed care claims analysis. The American Journal of Medicine, 116(12), 835-42.
Ofman JJ, et al. Utilization of Nonsteroidal Anti-inflammatory Drugs and Antisecretory Agents: a Managed Care Claims Analysis. Am J Med. 2004 Jun 15;116(12):835-42. PubMed PMID: 15178499.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Utilization of nonsteroidal anti-inflammatory drugs and antisecretory agents: a managed care claims analysis. AU - Ofman,Joshua J, AU - Badamgarav,Enkhe, AU - Henning,James M, AU - Knight,Kevin, AU - Laine,Loren, PY - 2003/03/18/received PY - 2004/02/02/accepted PY - 2004/6/5/pubmed PY - 2004/8/10/medline PY - 2004/6/5/entrez SP - 835 EP - 42 JF - The American journal of medicine JO - Am J Med VL - 116 IS - 12 N2 - PURPOSE: To describe patients initiating nonsteroidal anti-inflammatory drug (NSAID) therapy with regard to gastrointestinal and cardiac risks and patterns of antisecretory agent use, and to explore the relation between therapy type and subsequent outcomes. METHODS: We studied patients aged 18 years or older who had continuous coverage from 1998 to 2001 and who had initiated treatment with cyclooxygenase-2 (COX-2) selective inhibitors or nonselective NSAIDs. Patients were categorized with respect to gastrointestinal and cardiac risk profiles. Proton pump inhibitor use within 15 days of initiating NSAID therapy was considered prophylactic. Logistic regression analysis was used to evaluate associations between treatment and hospitalization events, cardiac events, and health care costs. RESULTS: We identified 106,564 eligible NSAID initiators: 65.2% used COX-2 inhibitors and 34.8% used traditional NSAIDs. Users of COX-2 inhibitors were more likely to be at higher risk of gastrointestinal bleeding and cardiac events than were NSAID users. Proton pump inhibitor prophylaxis was most common among users of COX-2 inhibitors, but was only 11% in patients at high risk of gastrointestinal bleeding. There were no differences among treatment groups in terms of gastrointestinal or cardiac events. Initiation of COX-2 inhibitor therapy was associated with greater total health care costs. CONCLUSION: Although we found that COX-2 inhibitors were used more frequently than were traditional NSAIDs in certain groups of patients with varying cardiac or gastrointestinal risk, we did not find that their use resulted in reductions in clinical events, cotherapy with proton pump inhibitors, or costs, suggesting that a better understanding of the relation between NSAID treatment strategies and outcomes in patients with differing risk characteristics is needed. SN - 0002-9343 UR - https://www.unboundmedicine.com/medline/citation/15178499/Utilization_of_nonsteroidal_anti_inflammatory_drugs_and_antisecretory_agents:_a_managed_care_claims_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002934304002128 DB - PRIME DP - Unbound Medicine ER -