NSAID Usage in U.S. Hospitals
The use of nonsteroidal anti-inflammatory drugs (NSAIDs) has risen more than 18% in the hospital setting in the last two years. Using data from our Hospital Diagnosis and Therapy Audit (HDTA), comparing the second quarter of 2002 with the same time period in 2000, MediMedia USA, Inc., evaluated patient characteristics such as age, sex, and diagnostic information. Most of the patients taking NSAIDs were women between the ages of 18 and 39 who were in the hospital for an obstetrical diagnosis; however, when the concomitant use of aspirin was examined, the patient profile and diagnoses changed dramatically. Although only 10% of the patients who received NSAIDS received aspirin as well, more than 50% of them were men and more than 90% were over age 40.
The difference in the diagnoses shows that most patients were being treated for cardiovascular problems but that the addition of aspirin increased the likelihood of a gastrointestinal (GI) co-morbidity. The prevalence of gastroesophageal reflux disease (GERD) was 3.5 times higher in the group receiving aspirin therapy than in patients receiving an NSAID alone.
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The same analysis was done for inpatients receiving COX-2 NSAIDs alone or with aspirin. In this case, the results were less notable. There was little difference between the ages or sex of members of the groups, and the diagnoses were almost identical. Most patients were being treated for a cardiovascular disorder; however, the difference in incidence of GI complications, such as gastroesophageal reflux, was less than 2%.
These data suggest that NSAIDs are being used as a first-line therapy for pain relief in younger, healthier patients, whereas physicians are reserving COX-2 NSAIDs for use in elderly patients. Because most of these older patients are probably suffering from a form of cardiovascular disease and might be taking aspirin, this prescribing practice is resulting in fewer gastrointestinal complications.
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The Hospital Diagnosis and Therapy Audit provides the means of analyzing inpatient activity, allowing pharmaceutical and biotechnology companies to monitor product and competitive strategic positions. The data are provided by a geographically diverse set of acute-care hospitals. MediMedia USA, Inc., provides a free benchmarking service for hospital pharmacies that is made available through PharmScope Insights. For 15 years, PharmScope has been helping hospitals monitor drug utilization, manage costs, and review length of stay and therapies, in order to improve the quality of patient care.
