Background Gastrointestinal (GI) toxicity is one of the major adverse effects of nonsteroidal antiinflammatory drugs (NSAIDs). Studies in several countries have demonstrated that NSAID-related gastropathy is associated with a considerable economic burden, which includes increased hospitalizations, physician visits, diagnostic tests and use of gastroprotective agents (GPAs) for prophylaxis or treatment.

Objectives This study estimated the gastropathy-related health care resource consumption and costs associated with prescriptions of NSAIDs, in a large cohort in Israel.

Methods We analysed the Maccabi clinical database which covers a population of 1.5 million. Patients who received any NSAID prescription between June 1998 and May 1999 were identified and sub-grouped according to patterns of NSAID consumption (incidental: 1–2 vs chronic: 3 or more prescriptions) and age (<65 vs 65 years or older). As a population baseline measure of gastropathy rate, age- and sex-matched controls, defined as patients who did not have any NSAID prescriptions during the study period, were randomly selected. Outcome measures included the use of GPAs, gastroenterologist consultations, gastroendoscopy and upper GI imaging tests. Hospitalizations for GI complications were not included in this study.

Results During the one-year study period, 194,814 patients were identified with a total of 365,624 NSAID prescriptions filled. About 82% were incidental users and 18% were chronic NSAID users. Overall, 22% of the NSAID users had GPA prescriptions, compared to 8% of matched controls (a 14% increase in GPA use for patients on NSAIDs). The increases in GPA use were higher among chronic NSAID users and those aged 65 years or older than incidental users and patients below 65 years (20–38% vs 9–10%). H2-blockers comprised 75–80% of the GPA prescriptions, whereas PPI comprised 20–25%. Thus, for each 1 NIS spent on NSAIDs, an additional 0.52 NIS were spent on the treatment or prevention of GI NSAID toxicity (ie, iatrogenic cost factor defined as NSAID drug plus GI costs divided by NSAID drug cost is 1.52); 70% of these costs were spent on GPAs.

Conclusion Our study showed that the healthcare expenditures for management of NSAID-related gastropathy in Israel were substantial and comparable to published data in other countries. This study may have underestimated the total economic impact of NSAID gastropathy in Israel since hospitalizations for GI complications were not included. Efficacy and safety should be the primary parameters for selecting an antiinflammatory agent. When cost is considered, policy and clinical decision-makers need to take into account the total economic impact, which, in addition to the acquisition costs of these agents, should include health care expenditures for diagnosing, treating and preventing GI side effects.