LAUSR

BACKGROUND Codeine containing compound analgesics (CCCA) are associated with dependence, and when taken in excess, significant risks of harm. A previous audit showed significant costs related to admissions for gastrointestinal complications of CCCA. Based on this and other evidence of harm, the Australian Therapeutic Goods Administration changed CCCA to prescription only in 2018. We aimed to identify the costs associated with codeine-related gastrointestinal complications and whether the schedule change in 2018 led to a reduced clinical and financial strain on the healthcare system. METHODS We conducted an audit of gastrointestinal admissions and associated costs of CCCA at a tertiary teaching hospital in Adelaide between 2016 and 2020. Patients were grouped by 2-year time periods before (Group 1) and following (Group 2) schedule change. Costs for the index presentation were multiplied for subsequent presentations. Costs and outcomes were compared for groups (standard statistics; p-value < 0.05 significant.) RESULTS: 340 patients (Group 1, n = 164; Group 2 n = 119) were identified, with the majority of these admitted due to nonsteroidal anti-inflammatories (NSAIDs) only. For CCCAs (NSAID-containing) the same patients were admitted repeatedly with a reduction from 31 to 8 admission (p = 0.005), following rescheduling. The total cost of CCCA admissions reduced from $AU 561691 for Group 1 to $AU 261764 for Group 2 (p<0.001). CONCLUSIONS Australian rescheduling of CCCA in 2018 resulted in a reduction in hospital admissions and costs related to gastrointestinal complications. The cost savings, even in a single hospital department, were substantial. This article is protected by copyright. All rights reserved.