Objectives To quantify prevalence, harms, and NHS costs in England of problematic oral non-steroidal anti-inflammatory drug (NSAID) prescribing in high risk groups. Design Population based cohort and economic modelling study. Setting Economic models estimating patient harm associated with NSAID specific hazardous prescribing events, and cost to the English NHS, over a 10 year period, were combined with trends of hazardous prescribing event to estimate national levels of patient harm and NHS costs. Participants Eligible participants were prescribed oral NSAIDs and were in five high risk groups: older adults (≥65 years) with no gastroprotection; people who concurrently took oral anticoagulants; or those with heart failure, chronic kidney disease, or a history of peptic ulcer. Main outcome measures Prevalence of hazardous prescribing events, by each event and overall, discounted quality adjusted life years (QALYs) lost, and cost to the NHS in England of managing harm. Results QALY losses and cost increases were observed for each hazardous prescribing event ( v no hazardous prescribing event). Mean QALYs per person were between 0.01 (95% credibility interval (CI) 0.01 to 0.02) lower with history of peptic ulcer, to 0.11 (0.04 to 0.19) lower with chronic kidney disease. Mean cost increases ranged from a non-statistically significant £14 (€17; $18) (95% CI −£71 to £98) in heart failure, to a statistically significant £1097 (£236 to £2542) in people concurrently taking anticoagulants. Prevalence of hazardous prescribing events per 1000 patients ranged from 0.11 in people who have had a peptic ulcer to 1.70 in older adults. Nationally, the most common hazardous prescribing event (older adults with no gastroprotection) resulted in 1929 (1416 to 2452) QALYs lost, costing £2.46m (£0.65m to £4.68m). The greatest impact was in people concurrently taking oral anticoagulants: 2143 (894 to 4073) QALYs lost, costing £25.41m (£5.25m to £60.01m). Over 10 years, total QALYs lost were estimated to be 6335 (4471 to 8658) and an NHS cost for England of £31.43m (£9.28m to £67.11m). Conclusions NSAIDs continue to be a source of avoidable harm and healthcare cost in these five high risk populations, especially in inducing an acute event in people with chronic condition and people taking oral anticoagulants. All data and the economic model code are available in the manuscript and supplementary materials.

中文翻译：

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估计与英格兰口服非甾体抗炎药高风险处方相关的危害的经济影响：基于人群的队列和经济建模研究


目的 量化英格兰高危人群中有问题的口服非甾体抗炎药 （NSAID） 处方的患病率、危害和 NHS 成本。设计 基于人群的队列和经济建模研究。设置 经济模型，估计与 NSAID 特异性危险处方事件相关的患者伤害，以及 10 年期间英国 NHS 的成本，结合危险处方事件的趋势，以估计患者伤害和 NHS 成本的全国水平。参与者 符合条件的参与者接受了口服非甾体抗炎药，分为五个高危组：没有胃保护的老年人（≥65 岁）;同时服用口服抗凝剂的人;或患有心力衰竭、慢性肾病或消化性溃疡病史的人。主要结局指标 危险处方事件的发生率，按事件和总体情况划分，贴现质量调整生命年 （QALY） 损失，以及英格兰 NHS 管理伤害的成本。结果 观察到每个危险处方事件的 QALY 损失和成本增加 （ v 无危险处方事件）。消化性溃疡病史患者每人的平均 QALY 低 0.01 （95% 可信区间 （CI） 0.01 至 0.02） 至慢性肾病患者低 0.11 （0.04 至 0.19）。平均成本增加范围从心力衰竭的 14 英镑（17 欧元;18 美元）（95% CI -71 至 98 英镑）到同时服用抗凝剂的人的 1097 英镑（236 至 2542 英镑）不等。每 1000 名患者的危险处方事件发生率从消化性溃疡患者的 0.11 例到老年人的 1.70 例不等。在全国范围内，最常见的危险处方事件（没有胃保护的老年人）导致 1929 年（1416 至 2452 年）QALY 丢失，损失 2 英镑。46m（£0.65m 至 £4.68m）。影响最大的是同时服用口服抗凝剂的人：2143 （894 至 4073） QALY 丢失，花费 £25.41m（£5.25m 至 £60.01m）。在 10 年中，损失的 QALY 总数估计为 6335 个（4471 至 8658 个），英格兰的 NHS 成本为 £31.43m（£9.28m 至 £67.11m）。结论 NSAIDs 仍然是这五个高危人群可避免的伤害和医疗保健成本的来源，尤其是在诱导慢性病患者和服用口服抗凝剂的人发生急性事件方面。所有数据和经济模型代码均可在手稿和补充材料中找到。