Estimating the economic effect of harm associated with high risk prescribing of oral non-steroidal anti-inflammatory drugs in England: population based cohort and economic modelling study

OBJECTIVES To quantify prevalence, harms, and NHS costs in England of problematic oral non-steroidal antiinflammatory drug (NSAID) prescribing in high risk groups. DESIGN Population based cohort and economic modelling study. SETTING Economic models estimating patient harm associated with NSAID specific hazardous prescribing events, and cost to the English NHS, over a 10 year period, were combined with trends of hazardous prescribing event to estimate national levels of patient harm and NHS costs. PARTICIPANTS Eligible participants were prescribed oral NSAIDs and were in five high risk groups: older adults (>= 65 years) with no gastroprotection; people who concurrently took oral anticoagulants; or those with heart failure, chronic kidney disease, or a history of peptic ulcer. MAIN OUTCOME MEASURES Prevalence of hazardous prescribing events, by each event and overall, discounted quality adjusted life years (QALYs) lost, and cost to the NHS in England of managing harm. RESULTS QALY losses and cost increases were observed for each hazardous prescribing event (v no hazardous prescribing event). Mean QALYs per person were between 0.01 (95% credibility interval (CI) 0.01 to 0.02) lower with history of peptic ulcer, to 0.11 (0.04 to 0.19) lower with chronic kidney disease. Mean cost increases ranged from a non-statistically significant 14 pound (<euro>17; $18) (95% CI -71 pound to 98) pound in heart failure, to a statistically significant 1097 pound (236 pound to 2542) pound in people concurrently taking anticoagulants. Prevalence of hazardous prescribing events per 1000 patients ranged from 0.11 in people who have had a peptic ulcer to 1.70 in older adults. Nationally, the most common hazardous prescribing event (older adults with no gastroprotection) resulted in 1929 (1416 to 2452) QALYs lost, costing 2.46m pound (0.65m pound to 4.68m) pound. The greatest impact was in people concurrently taking oral anticoagulants: 2143 (894 to 4073) QALYs lost, costing 25.41m pound (5.25m pound to 60.01m) pound. Over 10 years, total QALYs lost were estimated to be 6335 (4471 to 8658) and an NHS cost for England of 31.43m pound (9.28m pound to 67.11m) pound. CONCLUSIONS NSAIDs continue to be a source of avoidable harm and healthcare cost in these five high risk populations, especially in inducing an acute event in people with chronic condition and people taking oral anticoagulants.