Impact of Proton Pump Inhibitor Dosing on PPI Utilization Patterns Among Patients with Gastroesophageal Reflux Disease

Abstract

Purpose: To examine proton pump inhibitor (PPI) dosing frequency and its association with PPI therapy utilization among patients with gastroesophageal reflux disease (GERD). Methods: This retrospective administrative claims data analysis included patients with ≥1 pharmacy claim for a PPI from 1/1/2006-3/31/2007; the first claim date was the index date. Patients had GERD diagnoses (ICD-9-CM 530.1, 530.10-530.12, 530.3, 530.81, 530.85, 787.1) and continuous enrollment for 12 months pre- and post-index date. Index PPI dosing frequency (quantity dispensed/days supply) was measured during post-index period. Patients were assigned to frequency categories: once daily (QD) for frequency=1.0, twice daily (BID) for frequency=2.0, >BID for frequency>2.0. Adherence was measured with medication possession ratio (MPR) and defined as MPR≥0.80. PPI change was defined as ≥1 non-index PPI fill after index date. Descriptive analysis was conducted and significance was tested with t-test and chi-square. Results: The study included 174,619 patients with GERD. The mean age of the cohort was 51.1 (±12.7) years and 54.6% were female. Most (91.4%) were on QD regimen throughout the post-index period, 8.1% were on BID and 0.5% of the patients were on >BID and excluded from analysis. Among patients whose first (index) PPI fill was QD, 1.8% increased dosing frequency during post-index and 0.5% had both an increase and decrease in frequency; all others had no change in dosing frequency. Among patients whose index PPI fill was BID, 12.3% decreased frequency, 1.0% increased frequency, and 4.3% both increased and decreased frequency during post-index. More QD PPI users (25.8%) than BID PPI (18.1%) were adherent (p<0.0001). Mean (standard deviation) MPR among patients with QD PPI and BID PPI were 0.53 (0.35) and 0.47 (0.32), respectively (p<0.0001). PPI change occurred in 26.2% of QD patients and 28.3% of BID patients (p<0.0001). Among PPI changers, 91.1% of index QD users changed to a different PPI with QD dosing, 8.3% changed to a different PPI with BID dosing and 0.6% changed to different PPI with >BID dosing. Among PPI changes, 52.2% of index BID users changed to a different PPI with QD dosing, 44.6% changed to a different PPI with BID dosing and 3.2% changed to a different PPI with >BID dosing. Conclusion: Once-daily dosing of PPI was associated with higher likelihood of adherence. More than a quarter of GERD patients changed to a different PPI during the study period and a substantial proportion of BID PPI users continued on BID dosing on a different PPI. Sponsored by Takeda Pharmaceuticals North America, Inc., Deerfield, IL, USA. Disclosure: Ronnie Fass-Consultant: Takeda, Xenoport, Vecta, Eisai, Salix; Research Suuport: Takeda, Wyeth, AstraZeneca, Sucampo; Speakers Bureau: Eisai, Takeda Reema Mody, M Charisse DeLeon-Employee: Takeda Rachel Halpern, Laura Becker-Employee: i3 Innovus, a vendor to Takeda.