Comparison of nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 (COX-2) inhibitors use in Australia and Nova Scotia (Canada)

Abstract

Aims: Cyclooxygenase-2 (COX-2) inhibitors were marketed aggressively and their rapid uptake caused safety concerns and budgetary challenges in Canada and Australia. The objectives of this study were to compare and contrast COX-2 inhibitors and nonselective nonsteroidal anti-inflammatory drug (ns-NSAID) use in Nova Scotia (Canada) and Australia and to identify lessons learned from the two jurisdictions.

Methods: Ns-NSAID and COX-2 inhibitor Australian prescription data (concession beneficiaries) were downloaded from the Medicare Australia website (2001-2006). Similar Pharmacare data were obtained for Nova Scotia (seniors and those receiving Community services). Defined daily doses per 1000 beneficiaries day(-1) were calculated. COX-2 inhibitors/all NSAIDs ratios were calculated for Australia and Nova Scotia. Ns-NSAIDs were divided into low, moderate and high risk for gastrointestinal side-effects and the proportions of use in each group were determined. Which drugs accounted for 90% of use was also calculated.

Results: Overall NSAID use was different in Australia and Nova Scotia. However, ns-NSAID use was similar. COX-2 inhibitor dispensing was higher in Australia. The percentage of COX-2 inhibitor prescriptions over the total NSAID use was different in the two countries. High-risk NSAID use was much higher in Australia. Low-risk NSAID prescribing increased in Nova Scotia over time. The low-risk/high-risk ratio was constant throughout over the period in Australia and increased in Nova Scotia.

Conclusions: There are significant differences in Australia and Nova Scotia in use of NSAIDs, mainly due to COX-2 prescribing. Nova Scotia has a higher proportion of low-risk NSAID use. Interventions to provide physicians with information on relative benefits and risks of prescribing specific NSAIDs are needed, including determining their impact.

Figure 1

Overall nonsteroidal anti-inflammatory drug (NSAID), nonselective (ns)-NSAID, cyclooxygenase-2 (COX-2) inhibitor and meloxicam use in Australia and Nova Scotia between 2001 and 2006. COX-2 inhibitors NS (—○—); COX-2 inhibitors AUS (); ns-NSAIDs NS (—⋆—); ns-NSAIDs AUS (—⋆—); meloxicam NS (—▵—); meloxicam AUS (—▴—); All NSAIDs NS (—□—); All NSAIDs AUS ()

Figure 2

Nonsteroidal anti-inflammatory drug (NSAID) drug utilization 90% (DU_90%) in Australia and Nova Scotia between 2001 and 2006

Figure 3

Nonselective nonsteroidal anti-inflammatory drug (ns-NSAID) utilization by risk for gastrointestinal (GI) side-effects (blocks, left axis) and low/high risk ratio (lines, right axis) in Australia and Nova Scotia between 2001 and 2006. others not classified (); meloxicam (); high risk (); moderate risk (); low risk (); Low-risk / High-risk ratio ()