Adverse gastrointestinal bleeding associated with over-the-counter nonsteroidal anti-inflammatory drug use: a cost study in two Gauteng public hospitals

  • Theshni Govender University of the Witwatersrand
  • Martin Brand University of the Witwatersrand
Keywords: over-the-counter, analgesics, nonsteroidal anti-inflammatory drugs, upper gastrointestinal bleeding, cost


Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used analgesics worldwide. Unlike other classes of drugs, NSAIDs are increasingly available as an expanding range of over-the-counter (OTC) and prescription formulations. The mortality rate of individuals using chronic oral NSAIDs is one in five due to gastrointestinal complications. The economic implications to a challenged South African public healthcare system of treating serious, potentially preventable upper gastrointestinal bleeds attributed to the consumption of OTC NSAIDs does not appear to have been quantified. Method: A prospective observational study was conducted at Chris Hani Baragwanath Academic Hospital and Charlotte Maxeke Johannesburg Academic Hospital over a six-month period. Patients admitted to the surgical service with signs and symptoms of upper gastrointestinal bleeding were asked to complete a questionnaire-based survey. Clinical details were collected from patient files after they were discharged. The cost to treat each patient was calculated. Results: Over the study period, 321 patients were admitted with upper gastrointestinal tract (UGIT) bleeding. The total cost to treat patients included in the study sample (n = 253) was R10 463 668. Patients using NSAIDs (n = 215) consumed 88% (R9 194 698) of the expenditure, seven times more than the cost of treating patients who did not use NSAIDs (n = 38; p = 0.043). Of the 215 patients who used NSAIDS, 183 had purchased over-the-counter NSAIDs and consumed 73% of the total expenditure. Conclusion: Strict enforcement of existing regulations governing the distribution, sale and marketing of OTC NSAIDs as well as intensive consumer education of the adverse effects associated with NSAIDs usage are indicated in order to minimise the substantial financial cost to the public health system and morbidity to the South African population at risk.

Author Biographies

Theshni Govender, University of the Witwatersrand
MBBCh Department of Surgery University of the Witwatersrand
Martin Brand, University of the Witwatersrand
FCS(SA), PhD Department of Surgery University of the Witwatersrand
Original Research