Nonsteroidal anti-inflammatory drug usage and gastrointestinal outcomes in the Republic of Serbia

Abstract

This study assessed the utilization of prescription and over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) as well as the rate of self-medication with diclofenac, ibuprofen, and naproxen in the Braneechevo District of the Republic of Serbia. Estimation of gastrointestinal (GI) disease (morbidity) trends and GI toxicityassociated hospitalization were studied and direct costs due to NSAID-induced GI toxicity are presented. This descriptive, retrospective study addressed drug use and outcomes between 2004 and 2006 documented in the Health Insurance Fund database of the Pozarevac Public Pharmacy in the Pozarevac Public Health Centar of the Braneechevo District, which includes 200,503 inhabitants. Data type/selection were defined daily doses (DDD) per 1000 inhabitants per day for utilization of drugs, number of patients with ICD-9 diagnosis codes for GI disorders; GI hospitalization count (average annualy length of stay [in days] and number of GI hospitalizations); direct cost of hospital care. The OTC diclofenac use showed an increasing tendency: 6.2279; 6.5983; 8.2911 DDD units, as well as the utilization of OTC ibuprofen: 2.4389, 2.4899, 2.5776 DDD units, respectively (20042006), whereas OTC naproxen had relatively low utilization. In the same period, GI morbidity decreased: 9636, 7982, 7806, respectively, and the number of GI morbidity-associated hospitalizations increased 10.18% in 2005 and 15.06%, in versus 2004. The costs of GI morbidity-associated hospitalizations increased: 12.20% (2005) and 94.51% (2006), compared to 2004 costs with a positive correlation between utility of diclofenac and ibuprofen (self medication) and increased GI hospitalizations in Braneechevo.