419 The Costly Case of Proton Pump Inhibitors: A Single Center Experience

Abstract

INTRODUCTION: Proton pump inhibitors (PPI) are one of the cornerstones in the management of upper gastrointestinal bleed (UGIB) with the standard practice being initiating a continuous PPI infusion (CPI). In the recent years, several studies and meta-analysis have shown that there was no significant difference in major outcomes such as re-bleeding rates when using intermittent intravenous PPI (IIP) as compared to a CPI in non-variceal UGIB (2). However, most places in the USA still largely favor using the continuous infusion. Our study aimed to show the difference in patient costs of administering a CPI vs. IIP if evidence based practice was utilized in a single community hospital. METHODS: We retrospectively identified 212 CPI using our Electronic Health Record (EHR) and pharmacy database that were ordered at a community hospital in Ohio from June 2018 to May 2019 for patients who were admitted with a diagnosis of non-variceal upper GI bleed. A simple cost comparison analysis was done by Excel 2016 to compare the patient cost between CPI and IIP for the similar duration of use. RESULTS: Out of the 212 patients that were started on CPI, 54% were ordered by gastroenterologists as compared to 46% of which were started by all other physicians including internists, intensivists and ED physicians (Figure 1). The duration of the CPI tended to be longer (3.47 days) in adults >50 years as compared to adults < /= 50 years (2.58 days). There was a major difference in the cost of administering a CPI as compared to using IIP for a similar duration (Figure 2). The cumulative cost of CPI was 326,262 USD versus 108,810 USD for IIP (Figure 3). CONCLUSION: Although recent studies have showed that there was no difference in major outcomes in non-variceal upper gastrointestinal bleed when using intermittent PPI as compared to a continuous PPI infusion, this has changed neither the guidelines nor our practice of using a CPI. CPI is significantly more expensive as compared to an IIP for a similar duration of administration averaging up to $310 more per day. Our study showed that 217,452 USD could have been saved in 1 year by using IIP instead of CPI. A recent quality improvement study showed a significant reduction in costs when they used IIP instead of CPI in the management of non-variceal UGIB. Further studies comparing the cost effectiveness between CPI and IIP for non-variceal UGIB along with RCTs comparing the two might help revise the guidelines regarding their usage in the future.