To the Editor.
—The article by Dr Jones and colleagues1 presents an important but limited perspective of nonsteroidal anti-inflammatory drug (NSAID) prescription. While NSAID expenses are substantial, the major expenses are actually indirect—treatment of adverse effects and inadequate treatment of underlying diseases. Clinicians may wonder if cost savings still exist once the costs of treating ulcers, gastrointestinal bleeding, and other complications are considered. Given that 30% of indomethacin recipients have adverse effects of sufficient severity to require discontinuation,2 it is surprising that indomethacin would be considered a first-line medication.Physician perception of patient harm may not accurately reflect patient experience. Chart review (to document adverse effects, hospitalizations, or both) would be of interest. Patients who develop hospitalization-requiring adverse effects of medication often find themselves under the care of another physician (for that hospitalization) and may elect to obtain subsequent care elsewhere. Thus, physician perception may underestimate the frequency
Rothschild BM. Cost Savings and Prescribing Protocols for Nonsteroidal Anti-inflammatory Drugs. JAMA. 1996;276(7):525-526. doi:10.1001/jama.1996.03540070021014