Trend analysis of proton pump inhibitor consumption and expenditure: The real-world evidence.

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.

Vonoprazan versus Lansoprazole for the Initial Treatment of Reflux Esophagitis: A Cost-effectiveness Analysis in Japan.

Objective Gastroesophageal reflux disease (GERD) is a highly prevalent disorder that negatively affects patients' quality of life and reduces their work productivity. The medical expenses associated with the treatment of GERD are the highest among all digestive diseases. Current guidelines recommend the administration of a standard dose of proton pump inhibitor (PPI) for eight weeks as an initial GERD treatment. However, there is growing concern regarding the safety of PPI treatment. Recently, a novel potassium-competitive acid blocker (P-CAB), vonoprazan (VPZ), was approved for the treatment of reflux esophagitis in Japan and may provide clinical benefits in GERD treatment. This study was conducted to evaluate the cost-effectiveness of a P-CAB, VPZ vs. a PPI, lansoprazole (LPZ), for the acute medical treatment of reflux esophagitis. Methods A clinical decision analysis was performed using a Markov chain approach to compare VPZ to LPZ in the acute treatment of reflux esophagitis in Japan. Results The P-CAB strategy was superior to the PPI strategy in terms of cost-effectiveness (direct cost per patient to achieve clinical success) and the number of days for which medication was required. Sensitivity analyses revealed that this superiority was robust within the plausible range of probabilities. This remained true even when the healing rates in cases of mild esophagitis were applied. Conclusion The P-CAB strategy was consistently superior to the conventional PPI strategy using the original LPZ in terms of cost-effectiveness and the number of days for which medication was required. Thus, VPZ appears to be the drug of choice for the acute medical treatment of reflux esophagitis.

Cost-effectiveness analysis and effectiveness of pharmacist-managed outpatient clinics in Helicobacter pylori eradication therapy.

BACKGROUND: Helicobacter pylori is involved in many upper gastrointestinal diseases such as peptic ulcers and gastric cancers. In this study, we compared the cost-effectiveness of lansoprazole and vonoprazan in H. pylori eradication therapy and examined the effectiveness of pharmacist-managed outpatient clinics. METHODS: We investigated the efficacy and cost-effectiveness of pharmacist-managed outpatient clinics in H. pylori eradication therapy at our hospital from January 2015 to December 2017. The subjects were classified into three groups: lansoprazole group; vonoprazan group; and the medication instruction group, which received instructions at the pharmacist-managed outpatient clinics (intervention group). We examined the eradication rate and cost-effectiveness ratio of each group. RESULTS: The eradication rate of primary eradication therapy was 75.2% in the lansoprazole group, 87.8% in the vonoprazan group and 91.4% in the intervention group. When mental component summary was used as quality of life score, cost-effectiveness ratio was 224.7 yen in lansoprazole group, 223.9 yen in vonoprazan group and 222.2 yen in intervention group. Setting up pharmacist-managed outpatient clinics increases the pharmacist labour cost necessary for eradication therapy. However, if the medication instructions provided by the pharmacist can lead to improved disinfection efficiency, improvement in cost efficiency can be expected. CONCLUSION: Although medication instructions provided at the pharmacist-managed outpatient clinics incur additional labour costs, they improve patient quality of life as well as disinfection rate in H. pylori eradication therapy. Therefore, pharmacist-managed outpatient clinics are useful from the viewpoint of pharmacoeconomics.

Initiatives in South Africa to enhance the prescribing of generic proton pump inhibitors: findings and implications.

BACKGROUND: There have been multiple reforms in South Africa to conserve resources including policies to enhance generic use, such as compulsory generic substitution and copayments. However, there are concerns with the limited knowledge of their impact. OBJECTIVE: The objective was to determine utilization and expenditure of different proton pump inhibitors (PPIs). METHODOLOGY: A retrospective drug utilization study was conducted on a prescription database of a medical aid administrator in 2010. RESULTS: The limited prescribing of single-sourced PPIs accounted for 21.5% of total prescriptions. The limited use of originators omeprazole and lansoprazole accounted for 1.8 and 1.4% of total prescriptions for the molecule, respectively. Generic prices accounted for 36-68% of the originator in 2010. Patients received on average 2.91 PPI prescriptions during the year. CONCLUSION: Policies to enhance prescribing of generics appear working. Opportunities exist to further lower generic prices given low prices in some European countries.