{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:51:15Z","timestamp":1789044675691,"version":"build-2803163510"},"reference-count":48,"publisher":"BMJ","license":[{"start":{"date-parts":[[2024,7,24]],"date-time":"2024-07-24T00:00:00Z","timestamp":1721779200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"accepted":{"date-parts":[[2024,6,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To quantify prevalence, harms, and NHS costs in England of problematic oral non-steroidal anti-inflammatory drug (NSAID) prescribing in high risk groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Population based cohort and economic modelling study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Economic models estimating patient harm associated with NSAID specific hazardous prescribing events, and cost to the English NHS, over a 10 year period, were combined with trends of hazardous prescribing event to estimate national levels of patient harm and NHS costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Eligible participants were prescribed oral NSAIDs and were in five high risk groups: older adults (\u226565 years) with no gastroprotection; people who concurrently took oral anticoagulants; or those with heart failure, chronic kidney disease, or a history of peptic ulcer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Prevalence of hazardous prescribing events, by each event and overall, discounted quality adjusted life years (QALYs) lost, and cost to the NHS in England of managing harm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      QALY losses and cost increases were observed for each hazardous prescribing event (\n                      <jats:italic>v<\/jats:italic>\n                      no hazardous prescribing event). Mean QALYs per person were between 0.01 (95% credibility interval (CI) 0.01 to 0.02) lower with history of peptic ulcer, to 0.11 (0.04 to 0.19) lower with chronic kidney disease. Mean cost increases ranged from a non-statistically significant \u00a314 (\u20ac17; $18) (95% CI \u2212\u00a371 to \u00a398) in heart failure, to a statistically significant \u00a31097 (\u00a3236 to \u00a32542) in people concurrently taking anticoagulants. Prevalence of hazardous prescribing events per 1000 patients ranged from 0.11 in people who have had a peptic ulcer to 1.70 in older adults. Nationally, the most common hazardous prescribing event (older adults with no gastroprotection) resulted in 1929 (1416 to 2452) QALYs lost, costing \u00a32.46m (\u00a30.65m to \u00a34.68m). The greatest impact was in people concurrently taking oral anticoagulants: 2143 (894 to 4073) QALYs lost, costing \u00a325.41m (\u00a35.25m to \u00a360.01m). Over 10 years, total QALYs lost were estimated to be 6335 (4471 to 8658) and an NHS cost for England of \u00a331.43m (\u00a39.28m to \u00a367.11m).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>NSAIDs continue to be a source of avoidable harm and healthcare cost in these five high risk populations, especially in inducing an acute event in people with chronic condition and people taking oral anticoagulants.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj-2023-077880","type":"journal-article","created":{"date-parts":[[2024,7,24]],"date-time":"2024-07-24T20:15:17Z","timestamp":1721852117000},"page":"e077880","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Estimating the economic effect of harm associated with high risk prescribing of oral non-steroidal anti-inflammatory drugs in England: population based cohort and economic modelling study"],"prefix":"10.1136","volume":"386","author":[{"given":"Elizabeth M","family":"Camacho","sequence":"first","affiliation":[{"name":"Manchester Centre for Health Economics, Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonie S","family":"Penner","sequence":"additional","affiliation":[{"name":"Manchester Centre for Health Economics, Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Taylor","sequence":"additional","affiliation":[{"name":"Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK"},{"name":"NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce","family":"Guthrie","sequence":"additional","affiliation":[{"name":"Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony J","family":"Avery","sequence":"additional","affiliation":[{"name":"NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK"},{"name":"Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren M","family":"Ashcroft","sequence":"additional","affiliation":[{"name":"NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK"},{"name":"Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel R","family":"Morales","sequence":"additional","affiliation":[{"name":"Clinical Research Fellow, Population Health and Genomics, University of Dundee, DD1 4HN, UK; Department of Public Health, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Rogers","sequence":"additional","affiliation":[{"name":"Manchester Centre for Health Economics, Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antony","family":"Chuter","sequence":"additional","affiliation":[{"name":"Manchester Centre for Health Economics, Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, UK"},{"name":"NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK"},{"name":"Patient author"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3650-0168","authenticated-orcid":false,"given":"Rachel A","family":"Elliott","sequence":"additional","affiliation":[{"name":"Manchester Centre for Health Economics, Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, UK"},{"name":"NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,7,24]]},"reference":[{"key":"2025110102364473000_386.jul24_18.e077880.1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.0809"},{"key":"2025110102364473000_386.jul24_18.e077880.2","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp16X684433"},{"key":"2025110102364473000_386.jul24_18.e077880.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60900-9"},{"key":"2025110102364473000_386.jul24_18.e077880.4","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.329.7456.15"},{"key":"2025110102364473000_386.jul24_18.e077880.5","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-055551"},{"key":"2025110102364473000_386.jul24_18.e077880.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2009.04131.x"},{"key":"2025110102364473000_386.jul24_18.e077880.7","unstructured":"Medicines and Healthcare products Regulatory Agency . Guidance: Cox-2 selective inhibitors and non-steroidal anti-inflammatory drugs\u2019 (NSAIDs): Cardiovascular safety. 2015. https:\/\/www.gov.uk\/government\/publications\/cox-2-selective-inhibitors-and-non-steroidal-anti-inflammatory-drugs-nsaids-cardiovascular-safety \"\"."},{"key":"2025110102364473000_386.jul24_18.e077880.8","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmx142"},{"key":"2025110102364473000_386.jul24_18.e077880.9","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.14478"},{"key":"2025110102364473000_386.jul24_18.e077880.10","unstructured":"Bennett Institute for Applied Data Science . Openprescribing. 10.1.1: Non-steroidal anti-inflammatory drugs. 2023 https:\/\/openprescribing.net\/bnf\/100101."},{"key":"2025110102364473000_386.jul24_18.e077880.11","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)61817-5"},{"key":"2025110102364473000_386.jul24_18.e077880.12","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp14X679895"},{"key":"2025110102364473000_386.jul24_18.e077880.13","unstructured":"Pulse . TPP upgrades practice systems in wake of GMC prescribing error report. 17th August 2012. https:\/\/www.pulsetoday.co.uk\/news\/regulation\/tpp-upgrades-practice-systems-in-wake-of-gmc-prescribing-error-report\/"},{"key":"2025110102364473000_386.jul24_18.e077880.14","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq-2022-002002"},{"key":"2025110102364473000_386.jul24_18.e077880.15","doi-asserted-by":"publisher","DOI":"10.1007\/s41999-019-00181-5"},{"key":"2025110102364473000_386.jul24_18.e077880.16","doi-asserted-by":"publisher","DOI":"10.1007\/s40266-021-00907-w"},{"key":"2025110102364473000_386.jul24_18.e077880.17","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1004133"},{"key":"2025110102364473000_386.jul24_18.e077880.18","unstructured":"PRIMIS Team . PINCER National Rollout Progress Report to NHS England and the AHSN Network. 2020."},{"key":"2025110102364473000_386.jul24_18.e077880.19","unstructured":"England N . Medicines Safety Improvement Programme 2021 https:\/\/www.england.nhs.uk\/patient-safety\/patient-safety-improvement-programmes\/#MedSIP."},{"key":"2025110102364473000_386.jul24_18.e077880.20","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.2006.02698.x"},{"key":"2025110102364473000_386.jul24_18.e077880.21","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp14X677806"},{"key":"2025110102364473000_386.jul24_18.e077880.22","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-015-0327-2"},{"key":"2025110102364473000_386.jul24_18.e077880.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2021.11.1351"},{"key":"2025110102364473000_386.jul24_18.e077880.24","doi-asserted-by":"publisher","DOI":"10.1007\/s40266-019-00661-0"},{"key":"2025110102364473000_386.jul24_18.e077880.25","unstructured":"Open Prescribing . Search GP prescribing data: diclofenac suppositories (all). 2023 https:\/\/openprescribing.net\/analyse\/#org=CCG&numIds=1001010C0AAACAC&denom=nothing&selectedTab=chart."},{"key":"2025110102364473000_386.jul24_18.e077880.26","doi-asserted-by":"publisher","DOI":"10.1111\/joim.13505"},{"key":"2025110102364473000_386.jul24_18.e077880.27","unstructured":"National Institute for Health and Care Excellence . Guide to the methods of technology appraisal London. 2013: 1-93."},{"key":"2025110102364473000_386.jul24_18.e077880.28","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7119.1333"},{"key":"2025110102364473000_386.jul24_18.e077880.29","first-page":"s267","article-title":"Quantifying the impact of NSAID-associated adverse events","volume":"19","author":"Fine","year":"2013","journal-title":"Am J Manag Care"},{"key":"2025110102364473000_386.jul24_18.e077880.30","doi-asserted-by":"publisher","DOI":"10.1093\/oso\/9780198526629.001.0001"},{"key":"2025110102364473000_386.jul24_18.e077880.31","unstructured":"NHS Digital . Patients registered at a GP Practice 2022. https:\/\/digital.nhs.uk\/data-and-information\/publications\/statistical\/patients-registered-at-a-gp-practice."},{"key":"2025110102364473000_386.jul24_18.e077880.32","doi-asserted-by":"publisher","DOI":"10.1007\/s40122-020-00233-w"},{"key":"2025110102364473000_386.jul24_18.e077880.33","doi-asserted-by":"publisher","DOI":"10.2165\/00019053-199508060-00004"},{"key":"2025110102364473000_386.jul24_18.e077880.34","first-page":"S79","article-title":"Pharmacoeconomic aspects of non-steroidal anti-inflammatory drug gastropathy","volume":"31","author":"Walan","year":"1999","journal-title":"Ital J Gastroenterol Hepatol"},{"key":"2025110102364473000_386.jul24_18.e077880.35","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2004.02078.x"},{"key":"2025110102364473000_386.jul24_18.e077880.36","doi-asserted-by":"publisher","DOI":"10.2165\/00019053-200321090-00002"},{"key":"2025110102364473000_386.jul24_18.e077880.37","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/39.suppl_2.33"},{"key":"2025110102364473000_386.jul24_18.e077880.38","doi-asserted-by":"publisher","DOI":"10.1002\/art.21065"},{"key":"2025110102364473000_386.jul24_18.e077880.39","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-014-0148-8"},{"key":"2025110102364473000_386.jul24_18.e077880.40","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-021832"},{"key":"2025110102364473000_386.jul24_18.e077880.41","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.16388"},{"key":"2025110102364473000_386.jul24_18.e077880.42","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq-2022-002002"},{"key":"2025110102364473000_386.jul24_18.e077880.43","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2015.03.008"},{"key":"2025110102364473000_386.jul24_18.e077880.44","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j1909"},{"key":"2025110102364473000_386.jul24_18.e077880.45","doi-asserted-by":"publisher","DOI":"10.1185\/03007995.2011.633990"},{"key":"2025110102364473000_386.jul24_18.e077880.46","doi-asserted-by":"publisher","DOI":"10.1080\/00325481.2018.1429793"},{"key":"2025110102364473000_386.jul24_18.e077880.47","doi-asserted-by":"publisher","DOI":"10.1002\/pds.4955"},{"key":"2025110102364473000_386.jul24_18.e077880.48","unstructured":"Department of Health and Social Care . National overprescribing review report, 2021. https:\/\/www.gov.uk\/government\/publications\/national-overprescribing-review-report."}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj-2023-077880","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj-2023-077880","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T09:36:56Z","timestamp":1761989816000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj-2023-077880"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,24]]},"references-count":48,"alternative-id":["10.1136\/bmj-2023-077880"],"URL":"https:\/\/doi.org\/10.1136\/bmj-2023-077880","relation":{},"ISSN":["1756-1833"],"issn-type":[{"value":"1756-1833","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,24]]}}}