The economic consequences of NSAID-induced gastrointestinal damage.

The secondary gastrointestinal effects associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) are well documented in the medical literature. The "iatrogenic" cost arising from the treatment of these secondary effects, however, is less well known. Existing epidemiologic and clinical studies report that the cost of NSAIDs is multiplied by a coefficient that ranges from 1.36 to 3 when the cost of treating the induced gastroduodenal damage is taken into account. A simple methodology has been developed to calculate the "shadow price" of an NSAID by incorporating the costs of treating the gastroduodenal damage, thus yielding a figure that reflects the real economic burden of NSAID therapy. Using study data from seven countries, the cost effectiveness of prophylactic treatment with misoprostol--a prostaglandin analogue whose efficacy has been proven in the prevention of gastroduodenal ulcers in arthritic patients treated with NSAIDs--is reviewed. In the majority of cases, the financial benefits of preventing the ulcers equal or surpass the cost of prevention.