Proton pump inhibitors: potential cost reductions by applying prescribing guidelines.

Caitriona Cahir,Lesley Tilson,Conor Teljeur,Kathleen Bennett,Tom Fahey

doi:10.1186/1472-6963-12-408

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.

Highlights

There are concerns that proton pump inhibitors (PPI) are being over prescribed in both primary and secondary care
If PPI prescriptions were restricted generally to the recommended guidelines, what would the impact be on government drug expenditure? The aims of this study were to: (i) investigate trends in the duration and dose of PPI prescribing in a national community drug scheme in Ireland in a one year period 2007–2008; (ii) determine potential cost savings in a one year period (2007–2008) by examining different scenarios in prescribing patterns of PPIs according to clinical and cost-effectiveness guidelines and (iii) compare potential cost savings stratified by different age groups
PPI prescribing by age group Table 1 presents the percentage of patients prescribed PPIs for ≥3 consecutive months in 2007 by age distribution of the Health Services Executive (HSE)-Primary Care Reimbursement Services (PCRS) population and the proportion of those prescribed PPIs at maximum therapeutic dosage

Summary

Introduction

There are concerns that proton pump inhibitors (PPI) are being over prescribed in both primary and secondary care. Proton pump inhibitors (PPI) are indicated in the treatment of acid related dyspepsia and peptic ulcers and are one of the most frequently prescribed classes of drugs in the world [1]. The high volume of PPI prescribing may reflect the superior efficacy of PPIs and the relative lack of adverse drug effects and interactions compared to other acid inhibiting agents. In Ireland total expenditure on PPIs has increased from approximately €7 million in 1995 to €95 million in 2009. PPIs are one of the most expensive drug groups reimbursed in Ireland accounting for approximately 10% of overall drug expenditure [3]

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