Non-steroidal anti-inflammatory drugs: a suitable case for treatment?

Non-steroidal anti-inflammatory drugs (NSAIDs) are used widely throughout the world to relieve the symptoms of musculoskeletal disorders, in particular osteoarthritis and rheumatoid arthritis. These drugs produce significant side effects, including gastro-intestinal ulceration and the associated complications of perforation and bleeding. The relative toxicity of competing forms of branded and generic NSAID scary considerably. Their cost also varies considerably, often with the relatively more toxic formulations being more expensive. These characteristics, differing toxicity and cost, offer the possibility of reducing both adverse effects to patients and pharmaceutical expenditure if doctors’ behaviour can be changed. A tentative exploration of alternative patterns of NSAID use demonstrates that it may be possible to reduce expenditure below the 1994 level of around £175 million and reduce adverse events. An illustrative model shows that if prescribing was reduced by 25%, average dose reduced by 10% and patients switched to less toxic NSAIDS, up to £86 million could be saved, the number of serious adverse events per year reduced by 189 and the number of gastrointestinal complications reduced by 127. Such results may be achieved without reductions in the quality of life of patients using these drugs. Available clinical and economic information about NSAIDs is limited, with numerous published studies of poor quality which corrupt the knowledge base. Despite these problems there appears to be enough evidence to indicate that expenditure on NSAIDs could be considerably reduced and significant adverse effects could be avoided if general practitioners can be persuaded to change their prescribing behaviour. Inefficient and inappropriate prescribing of these often beneficial but sometimes dangerous drugs appears to be wasting scarce NHS resources and harming patients.