Background NSAIDs are frequently used in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). NSAID-induced UGI adverse events are well described in the Western population but data is lacking in Asian patients.
Objectives To describe the prevalence and direct healthcare costs of NSAID-induced UGI adverse events in a large cohort of RA and OA patients in Malaysia.
Methods A retrospective cohort study of RA and/or OA patients who received long-term NSAIDs (minimum 4 weeks prescription of any NSAID) between 2010 and 2013 was conducted in 4 large tertiary care centres with rheumatology units in Malaysia. Electronic clinical records and pharmacy prescriptions were reviewed. Resource use data was collected in patients who developed UGI adverse events within the 24 months follow up period. Unit costs were estimated by combining top down (general overheads for hospital services) and bottom up (activity-based costing for clinic visits, hospitalisation, diagnostic investigations, medications) approaches.
Results 634 patients were included in the final analysis with mean age 53.4±12.5 years, 90% female, diagnosis of RA in 60%, OA in 10% and both RA and OA in 30%. 45% and 8% of patients were on concomitant prednisone and aspirin respectively. 89% of patients had no previous upper GI disease. 59% and 41% of patients were grouped under non-selective and COX-2 inhibitor respectively. 84 (13.2%) patients developed UGI adverse events (Figure 1), consisting of 78 (12.3%) patients with dyspepsia, 5 (0.79%) with peptic ulcer disease (PUD) and 1 (0.16%) with upper GI bleeding (UGIB). The total direct cost was RM37,352 (USD 11,419) with a mean cost of RM447±535 (USD 137±163) per patient (Table 1). The largest cost components were pharmacotherapy (34%), oesophagoduodenoscopies (OGD) (23%) and outpatient visits (18%). The mean cost of dyspepsia was RM409±513 (USD 125±157) per patient. The mean cost of PUD and UGIB was approximately double (RM806±579) (USD 246±177) and quadruple (RM1,602) (USD 490) of dyspepsia respectively.
Conclusions The low prevalence of UGI adverse events in Malaysian rheumatology patients suggests judicious use of NSAIDs in tertiary care setting resulting in a low cost implication for the management of these events.
Disclosure of Interest None declared