Research proves prescribing certain drugs protects patients, saves money

By Dana Benson

For some patients – particularly the elderly – taking nonsteroidal anti-inflammatory medications, or NSAIDs, is a double-edged sword. The drugs offer pain relief but they can also present an increased risk of gastrointestinal bleeding, heart attack and stroke.

A series of studies led by Neena Abraham, M.D., assistant professor of medicine – gastroenterology at Baylor College of Medicine, may help lead to practices that reduce the risks associated with non-steroidal anti-inflammatory drugs, the most commonly prescribed drugs in the United States.

Cost effective

Her latest study dispelled one argument against offering at-risk NSAID users protection against gastrointestinal bleeding – that it would cost more to prescribe the stomach-protecting drugs than it would to treat the bleeding event.

Abraham's study, which was presented at the American College of Gastroenterology meeting in October, found that the U.S. Department of Veterans Affairs medical system would actually save money if physicians prescribed stomach-protecting drugs called proton pump inhibitors, or PPIs, for elderly patients taking the non-steroidal anti-inflammatory drugs. The proton pump inhibitors would help prevent stomach bleeding.

Previous research had already shown that the risk of gastrointestinal bleeding can be reduced by prescribing drugs such as Prilosec, Nexium or Aciphex.

VA study

Abraham and her research team studied veterans age 65 and older prescribed the non-steroidal anti-inflammatory drugs between 2000 and 2004 at Department of Veterans Affairs facilities. Results indicated that prescribing a proton pump inhibitor would cost the Department of Veteran Affairs $314 per veteran, but the increase in pharmacy cost would be offset by a $2,141 reduction in total medical cost per veteran.

The patients who took the proton pump inhibitors bled less frequently. If they did bleed, it was less serious and less expensive in health care costs than those who did not receive prescriptions for proton pump inhibitors, she noted.

"The bottom line was the reduction in medical costs outweighs the increase in pharmacy-related costs," Abraham said.

Through all of her research, Abraham said her goal is to improve the quality of care for the elderly, a group that is often underserved.

Few prescriptions

Her first study of these anti-inflammatory drugs was published in 2005. It showed that only 27.4 percent of patients at high risk for gastrointestinal bleeding events while taking non-steroidal anti-inflammatory drugs received prescriptions for the stomach-protecting drugs. Of those patients who did not receive the proton pump inhibitors, 87 percent were the elderly – the group that suffers the most from gastrointestinal bleeding.

"It's particularly important for physicians who work at the VA to be aware that the elderly are extremely high risk and need appropriate stomach-protecting medications," said Abraham, who conducts her clinical and research work at the Michael E. DeBakey Veterans Affairs Medical Center.

Some drugs withdrawn

While that study was ongoing, certain non-steroidal anti-inflammatory drugs called COX-2 selective drugs were withdrawn from the market because of their heart risks. That led to Abraham's second study, which showed that highly COX-2 selective drugs – those that offered the greatest pain relief – led to a 60 percent increase in risk for heart attack and stroke in elderly patients when compared to poorly COX-2 selective drugs.

"We found that it was a drug phenomenon. It wasn't a patient's cholesterol or diabetes or blood pressure control that was modifying that risk," Abraham said, adding that those drugs are now off the market and others that were in development never saw the light of day.

Ensuring that the study results are relayed to the public is an important next step, Abraham said.

Get the message out

"We need to get the message out to patients and their doctors and, more importantly, to the policymakers at the Department of Veterans Affairs," she said. "Really, that's the whole point of conducting research. It's not just an academic exercise."

Abraham's research is funded by a Department of Veteran Affairs Merit Award, which is the largest research award available through the VA.

The American College of Gastroenterology recognized her study on the economic impact of proton pump inhibitor prescriptions as the most significant research presented at its annual meeting last fall. Abraham was also a recent recipient of one of eight American Gastroenterological Association Foundation Research Scholars awards, which recognizes and supports young gastroenterologists who promise to make significant strides in research.