The Extent of Abuse of Proton Pump Inhibitor Therapy and Its Potential Consequences for the Patient and Impact on Health Care Costs

Abstract

Purpose: Proton Pump Inhibitor (PPI) agents are relatively safe and highly effective in offering symptomatic relief in patients with GERD, as part of triple therapy for H. Pylori and as gastric protective agents during NSAID therapy. A prescription for a PPI is often initially given without much thought on its need and renewed with much less scrutiny for months. Aim: To evaluate the extent of abuse of PPI therapy in a medical clinic of a teaching institution. To analyze the financial impact of the abusive use of PPI therapy. Methods: A chart review of 500 consecutive patients was conducted for the number of prescriptions for any one of the PPI agents (Esomeprazole, Lansoprazole, Omeprazole, Pantoprazole and Rabeprazole) and for their indication or the lack of it. Patients receiving PPI therapy were classified into three groups –Group 1– those who had a valid indication, Group 2– those who had a questionable indication (the Gray Zone – patients with nausea, vomiting, decreased appetite, abdominal pain of unknown etiology, viral/candida esophagitis, chronic dry cough) and Group 3– those who had no indication or even had achlorhydria. Results: Total number of patients on a PPI = 131 (26%)/500 The misuse of PPI therapy is anywhere between 15% to 42% (15% + 27%) (See Table 1)Table 1: GROUP RESULTS.Cost Analysis: The cost of therapy in: Group 3 = 20 patients X $4.94/day*=$36,062.00/year Group 2 =35 patients X $4.94/day*=$63,108.50/year Group 1 is not calculated since it was medically indicated. (*Mean cost of the available PPIs used once-daily. Prices from Walgreens.com effective 6/14/06). Conclusions: Once PPI therapy is initiated, for any reason, it is seldom discontinued. The financial impact on healthcare is substantial due to the high cost of PPI therapy. Potential side effects of PPI therapy, including increased susceptibility to C. Difficile colitis, Community Acquired Pneumonia, Vit. B12 malabsorption and Acute Interstitial Nephritis (AIN), are rarely assessed because of the feeling that PPIs are safe. Patients may be spending their limited resources on PPI therapy at the expense of other life saving medications.