Who gets prescriptions for proton pump inhibitors and why? A drug-utilization study with claims data in Bavaria, Germany, 2010\u20132018

Sebastian-Edgar Baumeister,Michael Nolde,Ute Amann,Jakob Linseisen,Roman Gerlach,Alexander Günter,Nayeon Ahn,Martin Tauscher,Florian Güntner,Christa Meisinger,Ina-Maria Rückert-Eheberg

doi:10.1007/s00228-021-03257-z

Abstract

PurposeThe German annual drug prescription-report has indicated overuse of proton pump inhibitors (PPIs) for many years; however, little was known about the characteristics of people using PPIs. This study aimed to provide comprehensive utilization data and describe frequencies of potential on- and off-label PPI-indications in Bavaria, Germany.MethodsClaims data of statutorily insured people from 2010 to 2018 were used. Defined daily doses (DDDs) of PPIs by type of drug, prevalence of PPI-use and DDDs prescribed per 1000 insured people/day were analyzed. For 2018, proportions of users and DDDs per 1000 insured people were calculated by age and sex. To elucidate changes in prescribing practices due to a suspected drug-drug interaction, we examined co-prescribing of clopidogrel and PPIs between 2010 and 2018. For PPI new users, sums of DDDs and frequencies of potential indications were examined.ResultsPPI prescribing increased linearly from 2010 to 2016 and gradually decreased from 2016 to 2018. In 2018, 14.7% of women and 12.2% of men received at least one prescription, and 64.8 DDDs (WHO-def.) per 1000 insured people/day were prescribed. Overall, omeprazole use decreased over the observation period and was steadily replaced by pantoprazole, especially when co-prescibed with clopidogrel. An on-label PPI-indication was not reported at first intake in 52.0% of new users.ConclusionsThe utilization of prescribed PPIs has decreased since 2016. However, a large proportion of new PPI-users had no documentation of a potential indication, and the sums of DDDs prescribed often seemed not to comply with guidelines.

Highlights

IntroductionProton pump inhibitors (PPIs) have spread around the globe and are labelled “lifestyle medications” not without reason
Almost like a pandemic, proton pump inhibitors (PPIs) have spread around the globe and are labelled “lifestyle medications” not without reason
The stratified figure shows that PPI-use depended on age: While 0.4% of the boys and 0.5% of the girls under 15 years of age received at least one prescription for PPIs in 2018, this proportion reached 40.2% and 43.4% in men and women aged 90 years and older, respectively

Summary

Introduction

Proton pump inhibitors (PPIs) have spread around the globe and are labelled “lifestyle medications” not without reason. For Germany, trends in PPI utilization and associated costs are regularly published by the German annual drug prescription-report [9]. These analyses do not elaborate on differences by sex and age, duration of intake, frequencies of indications, or other characteristics. The present analysis used claims data of all statutorily insured people in Bavaria, to describe trends in PPI-use from 2010 to 2018, to characterize utilization by sex and age, to examine if clopidogrel was prescribed less often together with omeprazole/esomeprazole, and to elucidate clinical PPI on- and off-label indications

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