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NSAID-Related Anemia Doubles Arthritis Costs
  By Nancy Walsh, Staff Writer, MedPage Today
Published: May 21, 2012

Action Points

· This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

· A database study found that osteoarthritis patients taking nonsteroidal anti-inflammatories (NSAIDs) who experienced a hemoglobin decrease of 2 g/dL or more had close to double the mean charges for inpatient and ambulatory care as controls taking NSAIDs without a significant change in hemoglobin.

· Note that in the six months prior to the drop in hemoglobin, these patients had more cardiovascular comorbidities and incurred significantly higher healthcare utilization for hospitalizations and medications than controls.

SAN DIEGO -- When patients with osteoarthritis take nonsteroidal anti-inflammatory drugs (NSAIDs) and then develop anemia, the associated healthcare costs during the subsequent year can double, a researcher said here.

Among patients whose hemoglobin levels fell by 2 g/dL or more, the mean charges for inpatient and outpatient treatment plus medications were $42,368 compared with mean expenditures of $22,583 (P<0.0001) for those whose change in hemoglobin was negligible, being at or below 0.5 g/dL, said Jay L. Goldstein, MD, of the University of Illinois in Chicago.

"Previous studies have suggested that 3% to 6% of patients with osteoarthritis using NSAIDs have a decline in hemoglobin of 2 g/dL or more, which is not insignificant and doesn't include patients with an acute bleed," Goldstein said here during Digestive Disease Week.

Clearly the development of anemia has significant clinical impact on these patients' quality of life, physical functioning, and comorbidities, but little is known about the economic effect and healthcare utilization, he explained.

To explore this, he and his colleagues analyzed data from a large claims database that includes 15 million members annually, 97% having commercial insurance.

The 1,800 patients included in this analysis averaged 60 years of age, and two-thirds were women. All had been given at least one 90-day prescription for an NSAID for their osteoarthritis.

A total of 228 patients experienced a 2 g/dL decrease in hemoglobin, while 1,572 remained stable and were considered controls.

The index date was the first report of the hemoglobin loss in cases and the first measurement of hemoglobin for controls.

During the 6 months before the index date, cases had a higher Charlson comorbidity index, at 1.4 versus 0.5 for controls (P<0.0001), and more often had cardiovascular conditions such as stroke, angina, or peripheral vascular disease (P<0.0001).

In addition, 38% of cases had been hospitalized compared with 4% of controls (P<0.0001), and 37% had used medications including proton pump inhibitors, compared with 26% of controls (P<0.0001).

"Notably, the baseline hemoglobin was identical in the two groups, at 14 g/dL," Goldstein said.

Health resource utilization during the 6 months after the index date was elevated among cases, as was seen by their likelihood of these procedures versus controls:

· Colonoscopy, adjusted OR 2 (95% CI 1.2 to 3.2)

· Upper gastrointestinal endoscopy, adjusted OR 3.5 (95% CI 2.1 to 6)

· Capsule endoscopy, adjusted OR 28.3 (95% CI 1.7 to 464.2)

· Any endoscopic procedure, adjusted OR 2 (95% CI 1.3 to 3)

"This represented a surprisingly low rate of endoscopy, with four out of five patients in this age group not having any evaluation," he said.

During the 12 months after the index date, the adjusted odds ratio for hospitalization among patients with anemia was 0.3 (95% CI 0.2 to 0.4) compared with an odds ratio among controls of 0.15 (95% CI 0.13 to 0.18, P<0.0001).

And during that year, the odds ratio for any outpatient visit or procedure among cases was 25.1 (95% CI 22.9 to 27.5) compared with 18.7 (95% CI 18 to 19.6, P<0.0001) in controls.

"These findings demonstrate the significant economic burden associated with a hemoglobin decline of 2 g/dL or more among patients with osteoarthritis receiving NSAID treatment. The data support this as a clinically relevant endpoint in outcomes trials," concluded Goldstein.

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