Impact of COX‐2 Inhibitors in Thai Orthopaedic Outpatients

Abstract

ABSTRACTBackgroundPrescribing of cyclo‐oxygenase ‐2 inhibitors (coxibs) has had an economic impact on patients and overall healthcare costs in Thailand.AimTo analyse the pattern of coxib use and to determine the cost impact of inappropriate use.MethodA random retrospective sample was selected from two months of prescribing data. There were 519 prescriptions for coxibs and 594 prescriptions for conventional non‐steroidal anti‐inflammatory drugs (NSAIDs). Appropriate use was based on the UK National Institute for Clinical Excellence criteria.Results208 (40%) patients receiving coxibs and 113 (19%) patients receiving conventional NSAIDs were at high risk for upper gastrointestinal adverse effects. Of those receiving coxibs, 112 (22%) received coxibs alone and 159 (31%) also received gastro‐protective agents. The cost of inappropriate use of coxibs in patients at a low risk of gastrointestinal effects was 2.4 million Baht/year. The excess cost, adjusted for the most commonly prescribed conventional NSAIDs (diclofenac 25 mg, Voltaren 25 mg, and ibuprofen 400 mg), were 3.4, 1.1 and 3.2 million Baht/year, respectively.ConclusionInappropriate use of coxibs resulted in excessive expenditure and specific pharmacy intervention would be required to reduce the cost impact.