Correlates and economic outcomes of proton pump inhibitor use by routes in intensive care unit patients

Abstract

Objectives were to evaluate correlates, and economic outcomes of proton pump inhibitor (PPI) use by route in the intensive care unit from an institutional-payer perspective. A 13-month retrospective study of electronic medical records was conducted of 534 adult (≥19 year-old) intensive care unit patients receiving a PPI (39% enteral-only, 34% parenteral-only, 27% both-route) in a Midwest USA academic medical center. Possible cost-savings with sensitivity analysis were estimated as differences in drug costs (US dollars) between switch eligible parenteral and alternate enteral-PPI medication doses. In multivariate logistic-regression of switch criteria (any oral-medication, orogastric-tube, nothing by oral route), significant correlate for enteral versus parenteral PPI-use was any oral-medication use but not orogastric-tube. Using enteral esomeprazole/lansoprazole instead of parenteral (esomeprazole/pantoprazole) PPI (in 37% i.e. 696 of 1895 switch-eligible doses) would have saved US$2384.17 or US$3564.86, respectively. By switching eligible patients on oral-medications or on orogastric-tube from parenteral- to enteral-PPI, institutions can realize significant drug cost-savings.

Strategies for reduction in the duration of intravenous drug use: Interest of drug tracers as quality indicators to improve intravenous to oral switch

“…As the majority of the patients admitted in hospital initially require intravenous medication, we chose in our center to promote IV to PO conversion using sequential therapy, i.e., replacing a parenteral medication with its oral counterpart of the same compound when possible. Our hypothesis was that reasons for inappropriate IV administration were the ability to swallow and the availability of a functioning gastric feeding tube, as suggested by a previous study that used similar criteria for IV to PO switch . For that purpose, we selected acetaminophen and PPI as drug tracers as they are widely used in our patients, with no regard on medical ward, and they could reflect all wards activities.…”