Comparison of Daily Average Consumption Between Different Proton Pump Inhibitors in Patients with Gastroesophageal Reflux Disease

Abstract

Purpose: Numerous randomized clinical trials have shown the benefits of proton pump inhibitors (PPIs) in patients with gastroesophageal reflux disease (GERD). Due to inadequate symptom control of once daily dosing, approximately 12-20% of patients use twice daily dosing of PPIs. The objective of this study was to compare daily average consumption (DACON) among GERD patients treated with different branded and generic PPIs. Methods: We conducted a retrospective database analysis using commercial enrollees from a large U.S. health plan from February 2008 to December 2009. Adult GERD patients with ≥1 medical claim with ICD-9 diagnosis codes 530.1, 530.10-530.12, 530.81, or 787.1, ≥1 PPI Rx claim during the identification period of February 2009 to September 2009, and continuous eligibility for 12 months before and 6 months after the index date were identified. The date of the first PPI Rx claim during the identification period was considered as the index date. DACON was defined as quantity of medication dispensed over the number of days with medication. We controlled for age, gender, region, GERD severity, plan type, pre-index Quan-Charlson comorbidity score (CCI), DACON, and costs and utilization. Results: Among 185,506 GERD patients identified, 2.3% were taking dexlansoprazole, 5.0% lansoprazole, 9.6% esomeprazole, 19.6% rabeprazole, 30.2% pantoprazole, and 33.3% omeprazole at the index date. Over half of the patients (56.47%) were branded PPI users and 43.53% (n=80,749) were generic PPI users at the index date. Patients in the branded PPI group were more likely to be younger (51.32 vs. 52.25 years, p<0.001), female (57.00% vs. 55.36%, p<0.001), reside in the southern part of the United States (57.65% vs. 48.00%, p<0.001), use point-of-service (56.54% vs. 53.06%, p<0.001) and exclusive provider organization (15.32% vs. 12.92%, p<0.001) health plans and had lower CCI (0.81 vs. 0.90, p<0.001) compared to patients in the generic PPI group. The highest DACON was among omeprazole users (1.32), followed by users of lansoprazole (1.20), rabeprazole (1.18), pantoprazole (1.16), esomeprazole (1.15) and dexlansoprazole (1.04). After risk adjustment, branded PPI users had a lower DACON (1.09 vs. 1.28, p<0.001) compared to generic PPI users. Conclusion: There were differences in DACON values between the different PPIs with dexlansoprazole showing the lowest and omeprazole showing the highest DACON. Branded PPI users showed lower DACON compared to generic PPI. The potential impact of reduced DACON on patient adherence, length of treatment and total and GERD-related healthcare resource utilization and costs requires further evaluation. Disclosure: Dr Mody - Employee: Takeda Pharmaceuticals International, Inc. All other authors were contracted research vendors for this study for Takeda Pharmaceuticals international, Inc. This research was supported by an industry grant from Takeda Pharmaceuticals International, Inc. funded this project.