Safety and Clinical Data
Cost Savings
The side effects of many common pharmaceuticals can be more costly than the disease itself. In 1999, the Centers for Disease Control reported more than 600,000 hospital admissions and 700,000 emergency room visits resulting from medications that were correctly administered but nonetheless produced serious side effects - from intestinal bleeding to seizures to even death. Because the elderly take the most drugs, they are at the greatest risk. On average, Americans who are 65 or older take six different medications every day, including prescription and over-the-counter drugs. For residents of nursing homes and other long term care facilities, that average drug burden rises to eight.
Very often a second drug is prescribed to alleviate the side effects caused by the first, and then a third drug to alleviate the symptoms caused by the first two, and so on. For example NSAIDs are associated with significant drug related morbidity and mortality. In the late 1990’s it was estimated 16,500 died and over 100,000 were hospitalized from NSAID induced GI bleeds1. The addition of proton pump inhibitors to NSAIDs decreases the rate of GI bleeds and dyspepsia by up to 50%2. The addition of a secondary increase in cost and complications such as osteoporosis from reduced calcium absorption3,4 and B12 deficiency from changes in gut flora are problematic5,6. Reduced compliance to therapy by increasing the number pills taken and frequency in dosing occurs7, 8, 9, 10. This complication accounted for one third of the total cost of arthritis care11,12. Patients over the age of 65, with concomitant medications and disease states are the most likely to suffer the side effects13.
- Wolff M, Lichtenstein D, Singh G. Gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs. N Engl J Med. 1999; 340(24):1888-99.
- Moore R, Derry S, Phillips C, McQuay H. NSAIDs, COX-2 selective inhibitors (coxibs) and gastrointestinal harm: review of clinical trials and clinical practice. BMC Musculoskeletal Disorders. 2006; 7:2474-9
- Gray S, LaCriox A, Larson J, et al. Proton pump inhibitor use, hip fracture, and change in bone mineral density in postmenopausal women: results from the Women’s Health Initiative. Arch Int Med. 2010; 170(9):765-71.
- Insogna K. The effect of proton pump-inhibiting drugs on mineral metabolism. Am J Gastro. 2009; 104(supp 2):S2-4
- Howden C. Vitamin B12 levels during prolonged treatment with proton pump inhibitors. J Clin Gastro. 2000; 30(1):29-33.
- Ito T, Jensen R. Association of long-term proton pump inhibitor therapy with bone fractures and effects on absorption of calcium, vitamin B12, iron, and magnesium. Curr Gastro Rep. 2010; 12(6):448-57.
- Thiefin G, Schwalm M. Underutilization of gastroprotective drugs in patients receiving non-steroidal anti-inflammatory drugs. Dig Liver Dis. 2011; 43(3):209-14.
- Duh M, Gosselin A, Luo R, et al. Impact of compliance with proton pump inhibitors on NSAID treatment. Am J Manag Care. 2009; 15(10):681-8.