Unnecessary NSAID Use Linked to Avoidable Health Problems and Medical Costs: Study

Taking common painkillers like Advil and Aleve when not medically needed contributes to an increased risk of adverse health effects, which results in dramatically higher healthcare costs, according to the findings of a new study.

Patients taking unnecessary non-steroidal anti-inflammatory drugs (NSAIDs) cost England £31 million, or more than $40 million, according to a report published on July 24 in the journal The BMJ.

NSAIDs are a class of prescription and over the counter (OTC) medications that are used to treat pain, reduce inflammation, and lower fever. The drugs include some of the most widely recognized brand-name over-the-counter products on the market, including Advil, Motrin, and Aleve. Prescription NSAIDs include Daypro, Relafen, Mobic, and Zorvolex.

Although these pain relievers are widely believed to be safe and carry few, if any, serious side effects, research indicates that the medications do increase the risk of stomach and intestinal bleeding, heart attacks, stroke, and kidney damage. Combining NSAIDs with antidepressants also increases the risk of bleeding in the brain, according to previous findings. In addition, research published in another study in The BMJ in 2023 found that taking NSAIDs with hormonal birth control increases the chance of forming blood clots and can lead to venous thromboembolism, a life-threatening blood clot that can move to the heart or lungs.

NSAID Health Risks and Health Costs

In this new study, researchers from the University of Manchester in the U.K., led by Rachel A. Elliott, professor of health economics, used economic models to estimate patient harms linked with NSAIDs and the cost to the English National Health System (NHS) over 10 years.

Researchers used trends of hazardous prescribing events and estimates of national levels of patient harm, along with total NHS costs gleaned from data from 1,060 general practices in England, which included more than 10.9 million patients, to estimate the average quality of life years per person (QALY) lost.

Participants were grouped into five high-risk categories, including older adults with no gastroprotection, people who took blood thinners, people with heart failure, chronic kidney disease, or a history of peptic ulcer.

According to the findings, using NSAIDs cost patients more than 6,000 years of good health. Older people with no gastroprotection lost more than 1,900 years of good health, while those taking blood thinners lost about 2,100 years of good health.

NSAIDs led to average healthcare cost increases ranging from roughly $18 for heart failure to $1,400 for those also taking blood thinners.

The risk NSAIDs posed led to an increase in healthcare costs overall. For older patients without gastroprotection, NSAID use costs the NHS about $3.1 million. For patients taking blood thinners, that led to healthcare costs of more than $32.6 million.

In total, across 10 years, taking NSAIDs led to a loss of 6,300 good years of health and cost the NHS more than $40.3 million.

The data indicates shorter durations of NSAID use were linked to lower risks, but that didn’t reduce all of the risks the drugs pose, since more than half of all health conditions caused by NSAIDs occurred in the first 1.5 years of treatment.

Researchers said focusing on reducing prescribing levels of NSAIDs on an individual level is needed, but they recognized how challenging that can be. The study authors said more research and awareness programs can help address the need, especially among high-risk patients.

“NSAIDs continue to be a source of avoidable harm and healthcare costs, despite a range of initiatives to reduce their use, especially in populations at high risk,” Elliot’s team concluded. “The risk of harm and associated costs appear to outweigh their benefit in these populations; therefore, a concerted effort should be made to continue to include NSAIDs in patient safety and deprescribing initiatives.”