1
|
Ferrara F, Capuozzo M, Celotto V, Ottaiano A, Langella R, Zovi A. Trend analysis of proton pump inhibitor consumption and expenditure: The real-world evidence. Indian J Gastroenterol 2024:10.1007/s12664-023-01501-1. [PMID: 38231298 DOI: 10.1007/s12664-023-01501-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/05/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Proton pump inhibitors (PPIs) constitute a widely utilized pharmaceutical class, frequently associated with notable instances of therapeutic inappropriateness. Such patterns of misuse not only contribute to elevated healthcare expenditure, but may also exacerbate clinical conditions in certain patients. METHODS A comprehensive analysis was conducted between 2019 and 2023 to assess all prescriptions dispensed using the Anatomical, Therapeutic and Chemical (ATC) classification system, which allowed trends among primary PPIs to be visualized. This was achieved by calculating the defined daily dose (DDD) and then defining the total expenditure incurred on these drugs. RESULTS With regard to the prescription of PPIs, an upward trend in consumption was observed with a decreasing expenditure, due to the phenomena of drug generics and increased competition between pharmaceutical companies, ranging from €9,512,481.22 in the first six months of 2019 to €8,509,820.80 in the first six months of 2023. From 2019 to 2023, consumption increased by approximately 3 million DDDs for a total ranging from 18,483,167.59 DDDs to 21,480,871.00 DDDs. Pantoprazole and esomeprazole, the most expensive drugs compared to omeprazole, rabeprazole and lansoprazole, accounted for 61.4% of therapies in the first six months of 2023, up from 2019, where these two drugs were prescribed 54.9%. CONCLUSION Within this analysis, we provide an illustrative representation of the prescribing trends for PPIs within a European context. Omeprazole, rabeprazole and lansoprazole appear to be the cheapest drugs compared to pantoprazole and esomeprazole. However, the results show that the most widely used PPIs, despite their therapeutic equivalence, are precisely the high-cost ones, thus generating higher expenditure for central governments.
Collapse
Affiliation(s)
- Francesco Ferrara
- Pharmaceutical Department, Asl Napoli 3 Sud, Dell'amicizia Street 22, 80035, Nola, Naples, Italy
| | - Maurizio Capuozzo
- Pharmaceutical Department, Asl Napoli 3 Sud, Marittima Street 3, 80056, Ercolano, Naples, Italy
| | - Venere Celotto
- Pharmaceutical Department, Asl Napoli 3 Sud, Castellammare, Naples, Italy
| | - Alessandro Ottaiano
- Istituto Nazionale Tumori Di Napoli, IRCCS "G. Pascale", Via M. Semmola, 80131, Naples, Italy
| | - Roberto Langella
- Italian Society of Hospital Pharmacy (SIFO), SIFO Secretariat of the Lombardy Region, Carlo Farini Street, 81, 20159, Milan, Italy
| | - Andrea Zovi
- School of Advanced Studies, University of Camerino, Via Madonna delle Carceri, 9, 62032, Camerino, Italy.
| |
Collapse
|
2
|
Dutta AK, Jain A, Jearth V, Mahajan R, Panigrahi MK, Sharma V, Goenka MK, Kochhar R, Makharia G, Reddy DN, Kirubakaran R, Ahuja V, Berry N, Bhat N, Dutta U, Ghoshal UC, Jain A, Jalihal U, Jayanthi V, Kumar A, Nijhawan S, Poddar U, Ramesh GN, Singh SP, Zargar S, Bhatia S. Guidelines on optimizing the use of proton pump inhibitors: PPI stewardship. Indian J Gastroenterol 2023; 42:601-628. [PMID: 37698821 DOI: 10.1007/s12664-023-01428-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/10/2023] [Indexed: 09/13/2023]
Abstract
Proton pump inhibitors (PPIs) have been available for over three decades and are among the most commonly prescribed medications. They are effective in treating a variety of gastric acid-related disorders. They are freely available and based on current evidence, use of PPIs for inappropriate indications and duration appears to be common. Over the years, concerns have been raised on the safety of PPIs as they have been associated with several adverse effects. Hence, there is a need for PPI stewardship to promote the use of PPIs for appropriate indication and duration. With this objective, the Indian Society of Gastroenterology has formulated guidelines on the rational use of PPIs. The guidelines were developed using a modified Delphi process. This paper presents these guidelines in detail, including the statements, review of literature, level of evidence and recommendations. This would help the clinicians in optimizing the use of PPIs in their practice and promote PPI stewardship.
Collapse
Affiliation(s)
- Amit Kumar Dutta
- Department of Gastroenterology, Christian Medical College and Hospital, Vellore, 632 004, India.
| | | | - Vaneet Jearth
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Ramit Mahajan
- Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | | | - Vishal Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | | | | | - Govind Makharia
- All India Institute of Medical Sciences, New Delhi, 110 029, India
| | | | - Richard Kirubakaran
- Center of Biostatistics and Evidence Based Medicine, Vellore, 632 004, India
| | - Vineet Ahuja
- All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Neha Berry
- BLK Institute of Digestive and Liver Disease, New Delhi, 201 012, India
| | - Naresh Bhat
- Aster CMI Hospital, Bengaluru, 560 092, India
| | - Usha Dutta
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Uday Chand Ghoshal
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Ajay Jain
- Choithram Hospital and Research Center, Indore, 452 014, India
| | | | - V Jayanthi
- Sri Ramachandra Medical College, Chennai, 600 116, India
| | - Ajay Kumar
- Institute of Digestive and Liver Diseases, BLK - Max Superspeciality Hospital, New Delhi, 201 012, India
| | | | - Ujjal Poddar
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India
| | | | - Shivram P Singh
- Kalinga Gastroenterology Foundation, Cuttack, 753 001, India
| | - Showkat Zargar
- Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Kashmir, 190 011, India
| | - Shobna Bhatia
- Sir H N Reliance Foundation Hospital, Mumbai, 400 004, India
| |
Collapse
|
3
|
Blackett JW, Faye AS, Phipps M, Li J, Lebwohl B, Freedberg DE. Prevalence and Risk Factors for Inappropriate Continuation of Proton Pump Inhibitors After Discharge From the Intensive Care Unit. Mayo Clin Proc 2021; 96:2550-2560. [PMID: 33308869 DOI: 10.1016/j.mayocp.2020.07.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/28/2020] [Accepted: 07/23/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine the prevalence and risk factors for inappropriate discharge on proton pump inhibitor (PPI) therapy started in the intensive care unit (ICU) for stress ulcer prophylaxis. PATIENTS AND METHODS This was a retrospective cohort study of adults initiated on treatment with a PPI in any of 9 affiliated ICUs from January 1, 2014, to December 31, 2018. Patients were excluded if they had an appropriate long-term PPI indication. Logistic regression modeling was used to identify characteristics associated with discharge on treatment with an inappropriate PPI. RESULTS Of 24,751 patients admitted to an ICU, 4127 were initiated on treatment with a new PPI, with 2467 (60%) lacking a long-term PPI indication. Of these 2467, a total of 1122 (45%) were continued on PPI therapy after transfer to the floor and 668 (27%) were discharged on PPI therapy. On multivariable analysis, risk factors for inappropriate discharge on PPI therapy included having an upper endoscopy (adjusted odds ratio [aOR], 1.70; 95% CI, 1.08-2.66), admission to the surgical compared with medical ICU (aOR, 2.03; 95% CI, 1.32-3.10), and discharge to a nursing home or rehabilitation facility (aOR, 1.43; 95% CI, 1.04-1.96; and aOR, 2.29; 95% CI, 1.62-3.24, respectively). CONCLUSION Among patients started on treatment with a PPI in the ICU without an indication for outpatient PPI use, 27% (668 of 2467) were nonetheless discharged on PPI therapy. Medically complex and surgical ICU patients are at increased risk for receiving PPIs without appropriate documented indications, and careful review of medication lists at discharge should occur in these high-risk groups.
Collapse
Affiliation(s)
- John W Blackett
- Division of Digestive and Liver Diseases, Department of Medicine, New York Presbyterian Columbia University Medical Center, New York.
| | - Adam S Faye
- Division of Digestive and Liver Diseases, Department of Medicine, New York Presbyterian Columbia University Medical Center, New York
| | - Meaghan Phipps
- Division of Digestive and Liver Diseases, Department of Medicine, New York Presbyterian Columbia University Medical Center, New York
| | - Jianhua Li
- Department of Biomedical Informatics, New York Presbyterian Columbia University Medical Center, New York
| | - Benjamin Lebwohl
- Division of Digestive and Liver Diseases, Department of Medicine, New York Presbyterian Columbia University Medical Center, New York
| | - Daniel E Freedberg
- Division of Digestive and Liver Diseases, Department of Medicine, New York Presbyterian Columbia University Medical Center, New York.
| |
Collapse
|
4
|
Chhabra M, Jangra MS, Rashid M, Sharma P, Vidyasagar K. Pattern, severity, and outcome of adverse drug reactions in a tertiary care hospital: an evidence from a cross-sectional study. J Basic Clin Physiol Pharmacol 2021; 33:815-822. [PMID: 34160928 DOI: 10.1515/jbcpp-2020-0218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 05/05/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Study aim to describe the spontaneous reporting of the adverse drug reactions (ADRs) among the patients admitted to medicine department of a tertiary care hospital. METHODS A prospective observational study was conducted over a period of four months at the medicine department. On the daily basis, all the patients aged >18 years admitted to the internal medicine department were followed and analyzed for occurrence of ADRs. Naranjo scale was used to determine causal relationship between the ADRs and suspected drugs. The nature of ADRs and its severity was assessed using the Hartwig scale. RESULTS A total of 4,530 patients were screened for the ADRs, out of which 90 ADRs were developed in the 89 patients. The overall incidence of ADRs was found to be 1.96% in the studied population. The most common ADRs encountered during the study period were type A (augmented). The least number of ADRs were observed in the age group of 31-40 years. Furthermore, the more significant number of male patients suffered from a severe type of ADRs as compared to females. Sixteen ADRs were of the mucocutaneous type of reaction followed by dizziness in 12 cases. The higher number of patients recovering from the ADRs was in the age group 41-60 years. The outcomes of ADRs were not found to be statistically significant with gender and age groups. CONCLUSIONS There is a strong need to extend the monitoring and reporting of the ADRs to ensure the patient safety. However, the overall incidence of ADRs appeared to be less in our study, highlighting the need for strengthening reporting system of ADRs. The results indicate that elderly patients are at significant risk of developing ADRs.
Collapse
Affiliation(s)
- Manik Chhabra
- Department of Pharmacy Practice, Indo-Soviet Friendship College of Pharmacy, Moga, Punjab, India
| | | | - Muhammed Rashid
- Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, Adichunchanagiri University, B G Nagara, Karnataka, India
| | - Puneet Sharma
- Department of Pharmacy Practice, Indo-Soviet Friendship College of Pharmacy, Moga, Punjab, India
| | - Kota Vidyasagar
- Department of Pharmacy, University College of Pharmaceutical Sciences, Kakatiya University, Warangal, Telangana, India
| |
Collapse
|
5
|
Hong Y, Ye Z, Gao Z, Rao Y. Continuous improvement on the rationality of prophylactic injectable PPIs usage by a clinical pharmacist-led guidance team at a Chinese tertiary teaching hospital. J Int Med Res 2021; 48:300060520954729. [PMID: 33045898 PMCID: PMC7557690 DOI: 10.1177/0300060520954729] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective We aimed to evaluate the effects of a clinical pharmacist-led-guidance-team (CPGT) on improving rational prophylactic injectable proton pump inhibitor use (PIPU) and to explore the application of the Plan–Do–Check–Act (PDCA) method in promoting rational PIPU. Methods We conducted a retrospective study among 814 patients at a Chinese tertiary teaching hospital from January 2017 to December 2018. We enrolled 98 patients before the PDCA; 297 and 419 patients were included in first- and second-round PDCA cycles, respectively. The CPGT established the criteria for PIPU and conducted interventions, including medical record reviews, provision of feedback, clinician education, and outcome analysis. We analyzed the appropriateness and costs of PIPU before and after establishment of the PDCA cycle. Results Implementation of continuous CPGT-led intervention and a PDCA cycle significantly decreased the rate of irrational PIPU (53.06% vs. 8.57%), including duration, administration route, indication, and dosing frequency. Costs of total (USD 211.28 ± 162.33 vs. 53.17 ± 22.32) and inappropriate (USD 76.70 ± 59.78 vs. 2.25 ± 3.86) PIPU per patient were significantly reduced. The target compliance rate was 107.56%. Conclusion A CPGT can have an effective role in improving rational PIPU and optimizing administration through a PDCA cycle, to attain improved clinical and economic outcomes.
Collapse
Affiliation(s)
- Yun Hong
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ziqi Ye
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhe Gao
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuefeng Rao
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
6
|
Nair S, Sundar S, Cheeti S, Bajpai A, Deepika S, Thunga G, Rashid M, Acharya RV. Prevalence And Predictors Of Potentially Inappropriate Medication Use Among Elderly Patients Using Updated Beers Criteria 2019: A Single Centered Retrospective Analysis. Curr Drug Saf 2021; 17:24-33. [PMID: 33902417 DOI: 10.2174/1574886316666210423113916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/11/2020] [Accepted: 12/30/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Inappropriate medication use poses a sizable health safety hazard in the elderly owing to aging-associated physiological and anatomic changes. Inappropriate drug prescribing and polypharmacy in this population elevates the risk of adverse drug reactions (ADR). To assess the prevalence and predictors of Potentially Inappropriate Medication (PIM) use in elderly patients according to updated Beers Criteria 2019. METHOD Medical Records of 402 patients aged ≥65 years admitted a tertiary care hospital from June 2018 to May 2019 were analyzed. The patients who experienced at least one PIM based on the 2019 Updated Beers Criteria were considered as cases and others as control. Data were presented as descriptive statistics and logistic regression was performed to assess the factors affecting the outcomes. RESULT The mean age was found to be 73.7 ±6.4 years in the test and 70.5±5.5 years in the control group. The prevalence of PIMs to be used with caution was found to be 54%. Whereas the prevalence of PIMs to be avoided and to be used with reduced dose was found to be 45% and 1% respectively. The most prescribed PIMs were aspirin, diuretics, long-acting sulfonylureas, and proton pump inhibitors (PPIs). Increasing age, polypharmacy, and the number of drugs in medication history were significantly (P<0.05) correlated with a substantial risk of PIM use. The risk of developing serious and moderate drug-drug interactions (DDIs) was significantly high in the test group (P<0.05) when compared to the control group. CONCLUSION A high prevalence of PIMs was observed in this study. Age, polypharmacy and ≥3 drugs in medication history were identified as risk factors for PIM use and were at a higher risk of developing DDIs. Continuous medication review by clinical pharmacists can aid in reducing the occurrence of PIMs amongst geriatrics.
Collapse
Affiliation(s)
- Sreedharan Nair
- Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Pharmacy Practice, India
| | - Syam Sundar
- Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Pharmacy Practice, India
| | - Srilakshmi Cheeti
- Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Pharmacy Practice, India
| | - Aditi Bajpai
- Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Pharmacy Practice, India
| | - S Deepika
- Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Pharmacy Practice, India
| | - Girish Thunga
- Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Pharmacy Practice, India
| | - Muhammed Rashid
- Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Pharmacy Practice, India
| | - Raviraja V Acharya
- Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Pharmacy Practice, India
| |
Collapse
|