Clinical and cost impact of intravenous proton pump inhibitor use in non-ICU patients

Nasser, Soumana C.; Nassif, Jeanette G.; Dimassi, Hani

doi:10.3748/wjg.v16.i8.982

Cited by 31 publications

(38 citation statements)

References 16 publications

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“…Only a small number of studies have examined the effectiveness of this prophylactic attitude in non-ICU patients [9,15], as well as its cost impact [16,17], and none were proper prospective controlled studies. These studies have shown a higher incidence of bleeding, but there were major differences in the populations considered in each one.…”

Section: Discussionmentioning

confidence: 99%

“…These studies have shown a higher incidence of bleeding, but there were major differences in the populations considered in each one. Some of those particular characteristics included patients initially admitted to ICUs [6,15], patients submitted to major surgeries [16,17], including organ transplant [6], and patients with prolonged times of admission (more than 14 days) [6]. All these are relevant factors which are not present in typical medical patients, admitted to internal medicine wards.…”

Section: Discussionmentioning

confidence: 99%

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Stress-related mucosal disease: Incidence of bleeding and the role of omeprazole in its prophylaxis

Amaral

Favas

Alves

et al. 2010

European Journal of Internal Medicine

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Background: Upper gastrointestinal bleeding is the severe complication of stress-related mucosal disease in hospitalized patients. In intensive care units (ICU), risk factors are well defined and only mechanical ventilation and coagulopathy proved to be relevant for significant bleeding. On the contrary, in non-ICU settings there is no consensus about this issue. Nevertheless, omeprazole is still widely used in prophylaxis of bleeding. The objective of our study was to evaluate the relevance of stress-related mucosal disease bleeding in patients admitted to an internal medicine ward, and the role of omeprazole in its prophylaxis. Methods: We conducted a retrospective study in which we analysed consecutive patients who were admitted to our ward over a year. We recorded demographic characteristics of the patients, potential risk factors for stress-related mucosal disease (clinical data, laboratory, and medication), administration of prophylactic omeprazole, and total cost of this prophylaxis. Patients with active gastrointestinal bleeding on the admission were excluded. We recorded every upper gastrointestinal bleeding event with clinical relevance. Results: Five hundred and thirty-five patients, mean age 70 years, mean length of stay 9.6 ± 7.7 days; 140 (26.2%) patients were treated with 40 mg of omeprazole intravenously, 193 (36.1%) with 20 mg of omeprazole orally, and 202 (37.8%) patients had no prophylaxis. There was only one episode (0.2%) of clinically relevant bleeding. Conclusion: In patients admitted to an internal medicine ward, incidence of upper gastrointestinal bleeding as a complication of stress-related mucosal disease is low. We found that there is no advantage in prophylaxis with omeprazole.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Stress-related mucosal disease: Incidence of bleeding and the role of omeprazole in its prophylaxis

Amaral

Favas

Alves

et al. 2010

European Journal of Internal Medicine

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“…[5] Other similar studies have also concluded that of those patients who were prescribed a proton pump inhibitor, either during their stay at the hospital or upon discharge, a significantly large percentage were guideline non-compliant. [2,3,4,5,6,7] A recent study performed in the state of Maryland incorporated two different hospitalist groups: academic and non-academic hospitals. All PPI prescriptions dispensed at the hospitals were investigated in accordance to FDA guideline compliance.…”

Section: Non-compliant Ppi Prescriptionsmentioning

confidence: 99%

“…Those involved in the study found that the total cost in a year of inappropriate PPI use, whether it be non-compliant indication or inappropriate documentation, was $233,994 [10] based on over-the-counter costs and $1,566,252 [10] based on average whole sale price costs. Another clinical study geared toward the cost impact of the overuse of proton pump inhibitors in non-ICU patients found that an annual cost savings of over $35,000 [6] could be possible if precautions were set in place to stop the non-compliant prescribing of PPIs.…”

Section: Economic Effect Of Ppi Overusementioning

confidence: 99%

Proton Pump Inhibitors: Their Misuse, Overuse, And Abuse

Atkins¹

2013

iosrphr

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“…According to one US study conducted in a university hospital, the inappropriate PPIs use contributed to potential increased cost of USD 37000 per year without involving the cost associated with potential risks of unnecessary therapy (Belfield et al, 2017). The cost burden associated with PPIs misuse can be minimized with the pharmacist intervention in reviewing prescribing orders for proper indications, route of administration and appropriate timing for switching from oral to intravenous (IV) preparations (Nasser et al, 2010). Moreover, it was highlighted that the physicians should advise their patients to elude the unnecessary use of PPIs because of its safety concerns particularly in the patients who are more prone to osteoporotic fracture (Yu et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Proton Pump Inhibitors Prescribing among Non-Critically Ill Hospitalized Patients in a Malaysian Tertiary Hospital

2017

J App Pharm Sci

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Background: There are raised concerns regarding the rational guidelines-based prescribing of proton pump inhibitors (PPIs) therapy in the hospital setting.Objective: To describe the current prescribing practice of PPIs among hospitalized patients in non-intensive care settings. Also, the study aimed to evaluate the appropriateness of the prescribed PPIs. Methods:A cross-sectional study was conducted in the medical ward of a tertiary hospital in the state of Pahang, Malaysia. A total of 153 medical records of non-critically-ill adult patients receiving PPI therapy were investigated. The assessment of PPI prescribing was performed referring to clinical guidelines and the list of PPI-approved indications. Results:The most frequently prescribed PPI regimen has been pantoprazole 40 mg OD. Approximately 34% of the prescribed regimens were considered to be appropriate as it was consistent with the clinical guidelines. However, about 31% of the prescribed PPIs did not have a clear indication. Moreover, the inappropriate use of PPIs was revealed in nearly 19% of the total PPIs prescriptions. Finally, 16% of the prescribed PPIs were in need of dosage adjustment due to the presence of drug-drug interactions with the concurrently used medications. Conclusion:Inappropriately prescribed PPIs are prevalent among non-critically ill-hospitalized adult patients in a Malaysian tertiary hospital. Initiatives for enforcing rational prescribing should focus on the proper documentation of evidence-based indications of PPIs in the medical records. There is a desperate need in the local setting for well-defined PPIs prescribing criteria. Future research should design and examine the impact of prescribing improvement interventions on the PPIs rational prescribing.

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Clinical and cost impact of intravenous proton pump inhibitor use in non-ICU patients

Abstract: This study highlights the over-utilization of IV PPIs in non-intensive care unit patients. Restriction of IV PPI use for justified indications and route of administration is recommended.

Cited by 31 publications

References 16 publications

Stress-related mucosal disease: Incidence of bleeding and the role of omeprazole in its prophylaxis

Stress-related mucosal disease: Incidence of bleeding and the role of omeprazole in its prophylaxis

Proton Pump Inhibitors: Their Misuse, Overuse, And Abuse

Evaluation of Proton Pump Inhibitors Prescribing among Non-Critically Ill Hospitalized Patients in a Malaysian Tertiary Hospital

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