NSAIDs: Risk-Benefit versus Cost-Benefit

Abstract

Nonsteroidal anti-inflammatory drugs (NSAIDs), salicylate and nonsalicylate, have provided a range of anti-inflammatory, analgesic choices that now characterize a $2 billion world market. Their ubiquitous use is not only reflected in physician prescribing patterns, but in the frequency of reports of adverse drug reactions (ADRs) to the US Food and Drug Administration surpassing all other alternative forms of medical therapy now prescribed. The ADR most commonly reflected is that of gastropathy with serious economic and morbid and even mortal outcomes, seen especially in the elderly and those requiring chronic use at high therapeutic doses. This has led to recent NSAID class labeling recommendations by the FDA that could lead to further required research and drug costs. Balanced against this are the hidden costs of hospitalizations and ADR complications interfering with successful anti-inflammatory therapy and progression of arthritis. This represents a risk-benefit that must be weighed against the cost-benefit of particular agents. That subset of patients most at risk could possibly favorably alter the response to these concerns with adequate gastroprotection and more conservative approaches relating to dosage and NSAID selecting strategies reviewed.