Proton pump inhibitors: potential cost reductions by applying prescribing guidelines

Abstract

BackgroundThere are concerns that proton pump inhibitors (PPI) are being over prescribed in both primary and secondary care. This study aims to establish potential cost savings in a community drug scheme for a one year period according to published clinical and cost-effective guidelines for PPI prescribing.MethodsRetrospective population-based cohort study in the Republic of Ireland using the Health Services Executive (HSE) Primary Care Reimbursement Services (PCRS) pharmacy claims database. The HSE-PCRS scheme is means tested and provides free health care including medications to approximately 30% of the Irish population. Prescription items are WHO ATC coded and details of every drug dispensed and claimants’ demographic data are available. Potential cost savings (net ingredient cost) were estimated according to UK NICE clinical guidelines for all HSE-PCRS claimants on PPI therapy for ≥3 consecutive months starting in 2007 with a one year follow up (n=167,747). Five scenarios were evaluated; (i) change to PPI initiation (cheapest brand); and after 3 months (ii) therapeutic switching (cheaper brand/generic equivalent); (iii) dose reduction (maintenance therapy); (iv) therapeutic switching and dose reduction and (v) therapeutic substitution (H2 antagonist).ResultsTotal net ingredient cost was €88,153,174 for claimants on PPI therapy during 2007. The estimated costing savings for each of the five scenarios in a one year period were: (i) €36,943,348 (42% reduction); (ii) €29,568,475 (34%); (iii) €21,289,322 (24%); (iv) €40,505,013 (46%); (v) €34,991,569 (40%).ConclusionThere are opportunities for substantial cost savings in relation to PPI prescribing if implementation of clinical guidelines in terms of generic substitution and step-down therapy is implemented on a national basis.

Effectiveness of a Multifaceted Intervention for Potentially Inappropriate Prescribing in Older Patients in Primary Care: A Cluster-Randomized Controlled Trial (OPTI-SCRIPT Study)

“…40,41 Reducing PIPrelated to proton pump inhibitors may also contribute to substantial savings as an estimated €22 million was spent on potentially inappropriate proton pump inhibitors in 2007. 42 Given the positive findings presented here, we plan to further model the intervention components to determine the effectiveness of the OPTI-SCRIPT intervention long term, and the potential impact it may have on cases of PIP other than for proton pump inhibitor prescribing.…”

Proton pump inhibitor prescribing patterns in the UK: a primary care database study

“…In the United Kingdom (UK), 11,126 thousand 22 prescriptions for PPIs were dispensed in 2000 2 , and this increased to 43,127 thousand in 23 2011 3 . Although the expenditure on PPIs has decreased in the UK since 2006 as a result of 24 government efforts to encourage the use of low-cost generic PPIs 4,5 , there has still been an 25 overall increase in the total number of PPI prescriptions dispensed 4 . For instance, in 2010, 26 PPIs became one of the top 20 drugs with the greatest net ingredient cost in the UK 4 .…”

Proton Pump Inhibitors for Stress Ulcer Bleeding Prophylaxis in Critically Ill Patients: A Cost Analysis Study

“…Overutilization is a factor that can increase medication cost and if the side effects due to overutilization it will have an impact on the increasing of the maintenance costs of the patient [19].…”