Have COX‐2 inhibitors influenced the co‐prescription of anti‐ulcer drugs with NSAIDs?

<jats:p><jats:bold>Aims </jats:bold> To quantify usage of COX‐2 inhibitors compared with nonselective NSAIDs and to determine their impact (including financial) on the co‐prescription of antipeptic ulcer (anti‐PU) drugs.</jats:p><jats:p><jats:bold>Methods </jats:bold> The Irish General Medical Services prescription database (covering 1.2 million people) was examined for NSAID prescriptions during December 1999‐November 2001. NSAID users were excluded during the first 6 months. During the next 12 months (study period) patients on NSAIDs (≥ 3 prescriptions) were identified. The study period and final 6 months provided data on co‐prescription of anti‐PU drugs. Age, gender, number of concomitant prescriptions, co‐prescribing of anti‐PU drugs and monthly cost were evaluated for 8 NSAIDs (<jats:italic>n</jats:italic>= 4 non‐selective NSAIDs and <jats:italic>n</jats:italic>= 4 COX‐2 inhibitors) and odds ratios (OR) calculated using logistic regression.</jats:p><jats:p><jats:bold>Results </jats:bold> COX‐2 inhibitors were prescribed more frequently in older, female patients and those receiving multiple medications. After adjustment for age, gender and polypharmacy, anti‐PU drugs were prescribed more frequently with COX‐2 inhibitors (OR = 1.31 (1.23,1.40)). COX‐2 inhibitors were up to 10‐fold more expensive, median monthly costs (including anti‐PU drugs) ranging from €34.61 (COX‐2 inhibitors) to €3.26 (nonselective NSAIDs).</jats:p><jats:p><jats:bold>Conclusions </jats:bold> Since COX‐2 inhibitors are associated with increased rates of co‐prescription of anti‐PU drugs and are more expensive than non‐selective NSAIDs, these results suggest that the expected cost‐savings with COX‐2 inhibitors may not be occurring in practice.</jats:p>