The iatrogenic costs of NSAID therapy: A population study

Sturkenboom, Miriam; Romano, Ferdinando; Simon, Giorgio; Correa-Leite, Maria L.; Villa, Marco; Nicolosi, Alfredo; Borgnolo, G; Bianchi-Porro, Gabriele; Mannino, Salvatore

doi:10.1002/art.10268

Cited by 50 publications

(31 citation statements)

References 29 publications

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“…The reduction in NSAID consumption is another important clinical achievement with significant health economic considerations (6). Not only direct costs (purchasing of NSAIDs), but also the indirect costs associated with management of side effects of NSAIDs, are saved.…”

Section: Discussionmentioning

confidence: 99%

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Viscosupplementation with Hyaluronic Acid in Hip Osteoarthritis (a review)

Abate¹,

Pelotti²,

Amicis³

et al. 2008

Upsala Journal of Medical Sciences

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Background: Viscosupplementation (VS) with hyaluronic acid (HA) is largely used for knee osteoarthritis therapy, but the evidences for its usefulness in hip osteoarthritis (OA) are limited. Methods: In this review, an extensive search of published trials on VS in hip OA was performed. From the selected papers the following data were extracted: sample size, inclusion / exclusion criteria, treatment procedures, evaluation methods, follow-up duration and clinical outcomes. Results: The level of evidence was low in quite all the trials (no placebo controlled groups). A reduction of pain and an improvement of function after 3 months, persistent in the long term (12 -18 months), was observed. Patients with mild morphological alterations responded better to therapy. Side effects were negligible, and were limited to pain and a sensation of heaviness in the injection site. No clear differences among Low (LMW) and High Molecular Weight (HMW) HA preparations were found in the clinical outcomes. However, for HMW-HA preparations, a lower number of injections was, in general, necessary in order to reach the therapeutic effect. Conclusions: Despite the initial promising results, some questions still remain open : 1) the characteristics of responders must be more precisely defined; 2) the treatment schedules, at present mainly based on the individual clinical experience, need a proper and accepted standardization. Finally, larger and placebo controlled trials are necessary to confirm the efficacy of VS in hip OA.

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Section: Discussionmentioning

confidence: 99%

“…Moreover, it is well known that these drugs, mainly in the elderly (3), may cause relevant side effects on gastrointestinal, renal, hepatic and cardiovascular apparatuses (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Viscosupplementation with Hyaluronic Acid in Hip Osteoarthritis (a review)

Abate¹,

Pelotti²,

Amicis³

et al. 2008

Upsala Journal of Medical Sciences

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“…16 We restricted our study to 2 groups, true acupuncture and sham acupuncture, and questions about the extent of the genuine clinical and placebo (purely psychological) effects of auricular acupuncture remain beyond the scope of our study. Given the cost of treating the side effects of commonly used nonopioid analgesics, 25 determining the cost-effectiveness of auricular acupuncture might be an interesting question for a future trial.…”

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confidence: 99%

Auricular acupuncture for pain relief after ambulatory knee surgery: a randomized trial

Usichenko¹,

Kuchling²,

Witstruck³

et al. 2007

Canadian Medical Association Journal

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A lmost 70% of operative procedures in North America are currently performed in an ambulatory setting.1 Despite advances in surgical techniques and modern methods of analgesia, 45% of patients suffer pain at home after ambulatory surgery, 2 and moderate to severe pain intensity at home is reported by 30% of ambulatory patients.3 Inadequate relief of pain after ambulatory surgery increases morbidity and health care costs and reduces patients' quality of life.4,5 To improve postoperative pain relief, an integrative approach combining pharmacologic methods and various complementary nonpharmacologic analgesic techniques has been recommended.6 Auricular acupuncture holds promise, as it is an easily performed technique that might be effective for treatment of both preoperative anxiety and postoperative pain in patients undergoing ambulatory surgery.7,8 However, there are reasonable doubts in the scientific community concerning the specificity of acupuncture, 9 because the large randomized trials on auricular acupuncture for treatment of cocaine and alcohol dependence have found no difference between treatment and invasive needle control. 10,11Thus, after refining the methodology in a pilot study, 12 we performed a randomized controlled trial to compare the postoperative analgesic effect of auricular acupuncture with invasive needle control in patients after ambulatory knee surgery. MethodsThis prospective, patient-and evaluator-blinded, controlled study was performed between August 2003 and September 2004 at the Ambulatory Orthopedic Surgery Center of the Ernst Moritz Arndt University, Greifswald, Germany. The study was approved by the university's ethics committee. Consecutive patients scheduled for arthroscopic ambulatory knee surgery under general anesthesia (without premedication) were enrolled in the study. Exclusion criteria were age younger than 18 years or older than 70 years; American Society of Anesthesiologists physical status III (severe systemic disease with functional limitation); history of opioid, sedative or hypnotic medication or excess alcohol use; inability to understand the consent form or how to use a visual analogue scale for pain measurement; local auricular infection or significant auricular deformation; or presence of prosthetic cardiac valves. Patients were withdrawn from the study if it was necessary to change the perioperative analgesia scheme, if the arthroscopic procedure was turned into open knee surgery or if the patient was unexpectedly admitted to hospital after the procedure.On the day before surgery the patients were told that they would receive auricular acupuncture at specific points or Auricular acupuncture for pain relief after ambulatory knee surgery: a randomized trial Background: Auricular acupuncture is a promising method for postoperative pain relief. However, there is no evidence for its use after ambulatory surgery. Our aim was to test whether auricular acupuncture is better than invasive needle control for complementary analgesia after ambulatory knee surgery. Methods:O...

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“…In Friuli Venezia Giulia, the Regional Health Authority has developed a data warehouse system that contains several years of data from administrative databases and allows for fast data mining. This system has been widely used for health service evaluation and epidemiological studies [25][26][27][28][29][30].…”

Section: Resultsmentioning

confidence: 99%

Risk-Adjusted Models of Costs Referable to General Practitioners Based on Administrative Databases in the Friuli Venezia Giulia Region in Northern Italy

Piergentili¹,

Simon²,

Paccagnella³

et al. 2015

Arch Community Med Public Health

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Objective: To develop risk adjustment models for cost evaluation in primary health care in Italy based on administrative databases. Setting:The 2007 administrative databases from the National Health Service of the Friuli Venezia Giulia Region were the data source. Data referred to the general population and included information on the use of health services (inpatient, outpatient, medication, home care) as well as on the major chronic health problems. Data included persons who, for their health condition, must not pay the contribution usually required for using health services (ticket exemption).Design: Multilevel (multivariate) statistical analysis, where the tariff of services or the price of drugs (both summed up and separated) were the dependent variables, and the health conditions and other variables related to the citizens were the predictive variables. Results:The analysis included 1,067,239 citizens registered with a General Practitioner (GP) and 1,129 GPs. The number of people with at least one ticket exemption was 461,532. A number of predictive models were developed, which considered the sum of all tariffs and prices, tariffs and prices of inpatient and outpatient services, and medications. The models had very robust results. The models explained a considerable share of the variation using the (R 2 1 ) parameter: the proportional reduction of error for predicting the level-1 dependent variable with respect to the model without any predictors. The R 2 1 was 44.6% for the sum of tariffs and expenditures, 30.9% for hospital tariffs, 27.1% for inpatient services and 49.3% for medications. The intra class correlation coefficient (ICC), which measures the proportion of residual variability due to the second level of analysis (GP), shows that, controlling for the Casemix, the amount of the residual variability driven by the GPs is very low or even negligible: 0.89% for total individual health care tariffs, <0.1% for inpatient services, 1.49% for outpatients services, and 2.0% for drug prescriptions. Discussion:The health status information provided by the ticket exemption database proved to be valid beyond the Researchers expectations, despite known data quality problems. The large study sample size may have played a role in these results. Primary health care risk adjustment can be performed using administrative databases instead of GP clinical records, making it much easier and less costly. The overall variation explained by the models was in line with the findings in the literature. The residual variation attributable to GPs was unexpectedly low. In the inpatient setting, this may be partly due to a systemic effort to reduce inappropriate hospitalisation. In the other settings this result came as a surprise, and may lead to a reconsideration of GP behaviour variation. Outcome and output measures in PHC without proper risk adjustment may lead to inaccurate findings.PHC in order to evaluate quality of care and cost containment on a systemic scale. In fact, hospital care can be viewed as part of the c...

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The iatrogenic costs of NSAID therapy: A population study

Cited by 50 publications

References 29 publications

Viscosupplementation with Hyaluronic Acid in Hip Osteoarthritis (a review)

Viscosupplementation with Hyaluronic Acid in Hip Osteoarthritis (a review)

Auricular acupuncture for pain relief after ambulatory knee surgery: a randomized trial

Risk-Adjusted Models of Costs Referable to General Practitioners Based on Administrative Databases in the Friuli Venezia Giulia Region in Northern Italy

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