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Clinical and economic implications of upper gastrointestinal adverse events in Asian rheumatological patients on long‐term non‐steroidal anti‐inflammatory drugs
Author(s) -
Pok Lydia Say Lee,
Shabaruddin Fatiha Hana,
Dahlui Maznah,
Sockalingam Sargunan,
Mohamed Said Mohd Shahrir,
Rosman Azmillah,
Lau Ing Soo,
Isa Liza Mohd,
Hussein Heselynn,
Ng Chin Teck,
Mahadeva Sanjiv
Publication year - 2018
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/1756-185x.13256
Subject(s) - medicine , adverse effect , rheumatoid arthritis , rheumatology , incidence (geometry) , upper gastrointestinal bleeding , retrospective cohort study , cohort , osteoarthritis , gastroenterology , alternative medicine , endoscopy , physics , pathology , optics
Aim To determine the incidence and direct costs of NSAID ‐induced upper GI adverse events in Malaysian rheumatology patients. Methods A retrospective, multi‐centre, cohort study of rheumatology patients on long‐term NSAID s was conducted. Clinical data of patients treated between 2010 and 2013 were collected for a 24‐month follow‐up period. The costs of managing upper GI adverse events were based on patient level resource use data. Results Six hundred and thirty‐four patients met the inclusion criteria: mean age 53.4 years, 89.9% female, diagnosis of rheumatoid arthritis ( RA ; 59.3%), osteoarthritis ( OA ; 10.3%) and both RA and OA (30.3%). Three hundred and seventy‐one (58.5%) patients were prescribed non‐selective NSAID s and 263 (41.5%) had cyclo‐oxygenase‐2 inhibitors. Eighty‐four upper GI adverse events occurred, translating into a risk of 13.2% and an incidence rate of 66.2 per 1000 person‐years. GI adverse events comprised: dyspepsia n = 78 (12.3%), peptic ulcer disease ( PUD ) n = 5 (0.79%) and upper GI bleeding ( UGIB ) n = 1 (0.16%). The total direct healthcare cost of managing adverse events was Malaysian Ringgit ( MR ) 37 352 ( US dollars [ USD ] 11 419) with a mean cost of MR 446.81 ± 534.56 ( USD 136.60 ± 163.42) per patient, consisting mainly of GI pharmacotherapy (33.8%), oesophagoduodenoscopies (23.1%) and outpatient clinic visits (18.2%). Mean cost per patient by GI events were: dyspepsia, MR 408.98 ± 513.29 ( USD 125.03 ± 156.92); PUD , MR 805.93 ± 578.80 ( USD 246.39 ± 176.95); UGIB , MR 1601.94 ( USD 489.74, n = 1). Conclusion The economic burden of GI adverse events due to long‐term NSAID s use in Malaysian patients with chronic rheumatic diseases is modest.