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

Abstract

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Cyclo‐oxygenase‐2 (COX‐2) inhibitors were marketed aggressively and their rapid uptake caused safety concerns and budgetary challenges in Canada and Australia. WHAT THIS STUDY ADDS • The study showed that there were similarities in the anti‐inflammatory prescribing pattern between Australia and Nova Scotia; however, volumes of both ns‐NSAIDs and COX‐2 inhibitors prescribed were higher in Australia in the study period. The remarkable increase observed in Australia in NSAIDs use was essentially due to the much higher COX‐2 inhibitor use. Differences in regulatory and marketing practices, as well as cultural and historical differences might be some of the reasons for differences in the NSAID prescribing between Australia and Nova Scotia. 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.

Differences in utilisation of gastroprotective drugs between 2001 and 2005 in Australia and Nova Scotia, Canada

“…Previous comparisons of utilisation of statin antilipemics, NSAIDs (COX‐2 specific and non‐specific), benzodiazepines and antidepressant medications between Nova Scotia, Canada (NS) and Australia (AUS) have been completed . In these studies, similar population groups were identified receiving publicly reimbursed medications, seniors (over 65 years of age) and social security recipients.…”

Non-Steroidal Anti-Inflammatory Drugs and Antibiotics Prescription Trends at a Central West Bank Hospital

“…22 A similar pattern was reported in Australia where non-selective NSAIDprescribing decreased while COX-2 inhibitor utilisation increased from 1997 to 2006. 23 Regarding the appropriateness of prescribing NSAIDs to the diagnosis, this study found that approximately 60% of the prescriptions were appropriate, whereas 14.4% were inappropriate. These findings are far worse than those reported by Irshaid et al, who showed that in a teaching hospital in Saudi Arabia a minority of outpatient NSAID prescriptions (4.2%) were inappropriate.…”

All‐cause mortality of elderly Australian veterans using COX‐2 selective or non‐selective NSAIDs: a longitudinal study

“…Meloxicam was a late entrant to the Australian market, establishing itself at a time when prescribers and the general public were aware of the cardiac risks associated with rofecoxib. Barozzi et al [24] have demonstrated the switch to meloxicam after the withdrawal of rofecoxib. By 2008, meloxicam had become the most widely subsidized NSAID on the Australian Pharmaceutical Benefits Scheme [25].…”