Proton Pump Inhibitors: Prescribing Practices, Appropriateness of Use, and Cost Incurred in a Tertiary Care, Public, Teaching Hospital in New Delhi, India

Abstract

Aims and Objectives: Proton pump inhibitors (PPIs) are the most commonly used drugs in healthcare systems. Their inappropriate use has been reported in several studies. This study was undertaken to assess the prescribing practices, appropriateness of use, and cost incurred on PPI in a tertiary care, public, teaching hospital in India. Methods: A total of 500 inpatients’ records and 600 outpatients’ prescriptions were analyzed. Extent of prescribing, dosing information given, and cost incurred on the use of PPI in both inpatients and outpatients was assessed. The appropriateness of PPI prescribed was analyzed only among inpatients. Results: PPIs were prescribed to 62.2% inpatients and 27% outpatients. Extent of use of PPI was maximum in medicine department in both inpatients (78.5%) and outpatients (44.5%). Complete dosing information was seen in 9.9% (inpatients) and 30.2% (outpatients) prescriptions. In all the prescriptions of outpatients, tablets/capsules were prescribed whereas in inpatients, 79.74% PPI were prescribed as injections. All PPIs were prescribed by branded generic names except three prescriptions in inpatients of the medicine department. Most common PPI prescribed was pantoprazole by the name of PANTOP in both inpatients and outpatients. The use of PPI was appropriate in 7.4% cases, inappropriate in 91% of the cases, and probable in 1.6% cases. Total cost incurred on the prescriptions of inpatients and outpatients was Rs. 10,04,102. Of this cost, Rs. 1,20,085 (11.95%) was spent on PPI. Cost incurred on PPIs in inpatients was Rs. 1,12,621 (11.65%) and in outpatients was Rs. 7463.67 (19.93%). Maximum cost was incurred on pantoprazole in both inpatients and outpatients. Conclusions: PPIs are being prescribed inappropriately to many patients resulting in a waste of economic resources. Lack of regular audits and feedback to prescribers could be the contributing factors. Educational interventions in rational prescription of PPIs are required to encourage their proper utilization for patients.