Prescribing non-steroidal anti-inflammatory drugs (NSAIDs) to people at high risk of harm is estimated to cost the NHS in England around £31 million and cause more than 6,000 lost years of good health over 10 years, finds a new study.
Published today in the BMJ, the researchers say NSAIDs continue to be a source of avoidable harm and healthcare costs, and that more needs to be done, especially in high risk populations.
NSAIDs are used for pain and inflammation and are one of the most widely prescribed groups of medicines in the world, but they cause a lot of harm, such as gastrointestinal bleeding, heart attacks, stroke, and kidney damage.
Yet despite a range of initiatives to reduce their use, NSAID prescribing is still common in people at high risk of harm due to older age, heart failure, chronic kidney disease, or those who are taking other medications that can increase bleeding risk.
To help inform policy in this area, researchers set out to estimate levels of patient harm and costs of high-risk NSAID prescribing to the NHS in England over a 10-year period.
The researchers identified rates of "hazardous prescribing events" for oral NSAIDs in five high risk groups: adults aged 65 and over with no gastroprotection; people with a previous peptic ulcer with no gastroprotection; people who concurrently took blood thinning drugs (anticoagulants); people with heart failure; and those with chronic kidney disease.
They then used economic models to estimate the harm associated with each hazardous prescribing event at the patient level, expressed as quality adjusted life years (QALYs) lost - a measure of years lived in good health - and the cost to the NHS in England of managing that harm.
The results show that average QALYs per person (where 1.0 is equivalent to perfect health and 0 is equivalent to being dead) were between 0.01 lower with previous peptic ulcer, to 0.11 lower with chronic kidney disease.
Average costs increased from a non-statistically significant £14 in heart failure to a statistically significant £1,097 in people also taking anticoagulants.
Rates of hazardous prescribing events per 1,000 patients ranged from 0.11 in people with a previous peptic ulcer, to 1.70 in older adults.
Nationally, the most common hazardous prescribing event (older adults without gastroprotection) results in 1,929 QALYs lost, costing £2.46 million, while the greatest impact is in people also taking anticoagulants, with 2,143 QALYs lost, costing £25.41 million.
Over 10 years, the five NSAID related hazardous prescribing events led to a total loss of 6,335 QALYs at a cost of £31.43 million to the NHS in England.
Shorter durations of exposure were associated with lower harms, but at least half of the observed harm occurred in the first 1.5 years of treatment.
These are observational findings, and the researchers point to several limitations around assumed dose, length of exposure, and accounting for all harms, which may have affected their estimates, and they note that results may not apply to other non-UK settings.
However, they say the types, severity and probability of NSAID-related harm are likely to be transferable, and further analyses to test the strength of the main findings yielded similar results, suggesting that they withstand scrutiny.
Our study shows that hazardous prescribing of non-steroidal anti-inflammatory drugs (NSAIDs) not only causes harm to patients, but this is also costly to the NHS.
He continued: "In particular, prescribing NSAIDs to patients who are also taking oral anticoagulants, or who have chronic kidney disease, is particularly costly in terms of the associated harms. It is important for clinicians to be aware of this: to avoid hazardous prescribing wherever possible and to review patients who are receiving hazardous prescriptions."
The researchers conclude: "NSAIDs continue to be a source of avoidable harm and healthcare costs, despite a range of initiatives to reduce their use, especially in high-risk populations.
"Given that the risk of harm and associated costs appears to outweigh their benefits in these populations, a concerted effort should be made to continue to include NSAIDs in patient safety and deprescribing initiatives."
