This was interesting too...
"Equivalent effect comes with fewer severe gastric adverse events, and lower rates of abnormal hemoglobin, a possible marker for lower bowel blood loss. The challenge now for topical NSAID is to confirm safety and economic benefit, and define the patients for whom they are the best choice."
jrheum.com./subscribers/04/10/1893.html
The challenge is a big one: data that ties the benefit of topicals to long-term cost savings.
The linkage is logical - but not empirically proven. It makes sense that health-care systems incur an extra cost to treat side-effects of using oral NSAIDs and COX2 inhibitors.
So far, these effects - and their costs have been hidden. What's needed now is a study that establishes a direct linkage between the effects of pills, and additional costs to the health-care system of treating those effects.
Figures have been estimated from available info, but the linkage hasn't been proven. We now know there's damage, but we haven't figured out the cost. If the extra cost to health-care systems turns out to be something like $1000 per patient, then Pennsaid starts to look very, very good.
That's probably what will be needed to change the minds of formularies.
That said, health-care practitioners, MHOs and insurers will find it difficult to ignore the evidence against oral NSAIDs and COX2 inhibitors when a less-dangerous alternative is available.
Jim |
