PMID- 23163956
OWN - NLM
STAT- MEDLINE
DCOM- 20130520
LR  - 20240318
IS  - 1472-6963 (Electronic)
IS  - 1472-6963 (Linking)
VI  - 12
DP  - 2012 Nov 19
TI  - Proton pump inhibitors: potential cost reductions by applying prescribing 
      guidelines.
PG  - 408
LID - 10.1186/1472-6963-12-408 [doi]
AB  - BACKGROUND: There 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. METHODS: 
      Retrospective 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). RESULTS: Total net ingredient cost was euro88,153,174 for claimants 
      on PPI therapy during 2007. The estimated costing savings for each of the five 
      scenarios in a one year period were: (i) euro36,943,348 (42% reduction); (ii) 
      euro29,568,475 (34%); (iii) euro21,289,322 (24%); (iv) euro40,505,013 (46%); (v) 
      euro34,991,569 (40%). CONCLUSION: There 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.
FAU - Cahir, Caitriona
AU  - Cahir C
AD  - HRB Centre for Primary Care Research, Division of Population Health Science, 
      Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland. 
      caitrionacahir@rcsi.ie
FAU - Fahey, Tom
AU  - Fahey T
FAU - Tilson, Lesley
AU  - Tilson L
FAU - Teljeur, Conor
AU  - Teljeur C
FAU - Bennett, Kathleen
AU  - Bennett K
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20121119
PL  - England
TA  - BMC Health Serv Res
JT  - BMC health services research
JID - 101088677
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Cost Savings/economics/methods
MH  - Databases, Factual
MH  - Drug Costs
MH  - Drug Substitution/economics/standards
MH  - Female
MH  - Humans
MH  - Ireland
MH  - Male
MH  - Middle Aged
MH  - *Practice Guidelines as Topic
MH  - Practice Patterns, Physicians'/economics/statistics & numerical data
MH  - Proton Pump Inhibitors/administration & dosage/*economics/therapeutic use
MH  - Retrospective Studies
MH  - Young Adult
PMC - PMC3529111
EDAT- 2012/11/21 06:00
MHDA- 2013/05/22 06:00
PMCR- 2012/11/19
CRDT- 2012/11/21 06:00
PHST- 2011/11/16 00:00 [received]
PHST- 2012/10/23 00:00 [accepted]
PHST- 2012/11/21 06:00 [entrez]
PHST- 2012/11/21 06:00 [pubmed]
PHST- 2013/05/22 06:00 [medline]
PHST- 2012/11/19 00:00 [pmc-release]
AID - 1472-6963-12-408 [pii]
AID - 10.1186/1472-6963-12-408 [doi]
PST - epublish
SO  - BMC Health Serv Res. 2012 Nov 19;12:408. doi: 10.1186/1472-6963-12-408.