Clinical Investigation
Potential Costs of Inappropriate Use of Proton Pump Inhibitors

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Abstract

Background

Proton pump inhibitors (PPIs) are commonly overused in hospitalized patients. The objectives of this study were to determine the extent of their inappropriate initiation in patients with low risk for gastrointestinal hemorrhage, factors associated with their continuation on discharge and potential cost of this trend.

Methods

Retrospective examination of patients with low risk for gastrointestinal hemorrhage admitted to a tertiary-care teaching hospital over a 3-month period who received esomeprazole. The following information was collected: age, gender, PPI status (de novo or continued) and admitting diagnoses. Additional information collected from the de novo subgroup included indication for PPI, number of days on PPI and continuation of the drug on discharge. The cost of the medication was obtained from pharmacy records.

Results

Four hundred nine patients were admitted during the study period and 204 (49.9%) received PPI de novo. Among these, 155 patients (76%) had an inappropriate indication for PPI. Of these, 62 (40%) patients were continued on PPI on discharge. Older age was a significant predictor of continuation of PPI at discharge. The estimated cost of the inpatient and outpatient inappropriate use of PPI was $12,272 and $59,272, respectively.

Conclusions

PPIs are overused in the majority of hospitalized patients with low risk for gastrointestinal bleeding and this practice gets perpetuated at discharge, especially in older patients. The cost of this phenomenon is alarming.

Section snippets

MATERIALS AND METHODS

A retrospective medical record review of all patients admitted to a teaching internal medicine service at a tertiary-care urban hospital between January 1 and March 31, 2010, was performed. Patients of either gender, with an age range of 20 to 99 years, who received 40 mg of oral esomeprazole once a day within 24 hours of admission, were selected for the study if they were deemed to have a low risk for gastrointestinal (GI) bleeding. For the purpose of the study, “low risk” for GI bleeding was

RESULTS

A total of 2,094 patients were admitted to this institution during the study period. Of these, 629 (30%) patients were started on PPI within 24 hours of admission. Two hundred twenty patients were excluded from the study as follows: 168 had GI-related admitting diagnoses including 91 with upper GI hemorrhage, 39 with lower GI hemorrhage, 9 with peptic ulcer disease and 29 with abdominal pain of uncertain causative factors. Another 52 patients were excluded because they required intensive care

DISCUSSION

In the current study, 75.9% patients receiving PPI de novo lacked an FDA-approved indication for their use; and 40% of these were continued on the drug at the time of discharge. The most common inappropriate indication in these patients was GI prophylaxis, although the medical record did not reveal an appropriate reason for such indication. The rate of inappropriate use of PPI in our study is similar to the one reported previously by other authors in other regions of the country and in Europe.

CONCLUSIONS

PPIs are overused in the majority of hospitalized patients with low risk for GI bleeding, and this practice gets perpetuated at discharge. In this study, older age was a significant predictor of continuation of PPI at discharge. The cost of this phenomenon is alarming and poses a significant burden to a healthcare system struggling to reduce its costs. Physicians should keep in mind the potential side effects and the possible increased 1-year mortality risk of these drugs to use them in a

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  • Cited by (0)

    The authors have no financial or other conflicts of interest to disclose.

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