Introduction

Proton pump inhibitors (PPIs) are one of the most widely prescribed drug groups in the UK. They are, however, often prescribed for extended periods of time at healing rather than maintenance doses, resulting in considerable additional costs for the NHS in both primary and secondary care¹. There are also often cost differentials between apparently equipotent (based on pharmacological and clinical trial data) agents². The aim of the present study was to assess the therapeutic and economic implications of using lansoprazole in place of omeprazole under normal practice conditions within the medical directorate of a tertiary referral teaching hospital for a range of indications

Methods

Study patients were those admitted over a four-month period to selected general medical wards with a history of simple dyspepsia, uncomplicated GORD or requiring NSAID prophylaxis. Intervention patients were those initiated on, or changed to lansoprazole from omeprazole. Patients already taking and continued on omeprazole on admission to hospital for the above indications were used as comparators. Upon giving their written, informed consent, all patients were questioned regarding their history of disease management and their symptoms were assessed using the Glasgow Dyspepsia Severity Scale Questionnaire (GDSS). Additional medical, demographic and socioeconomic data was collected via a medical chart review. Follow-up was 12 weeks after entry into the study via a pre-agreed telephone interview; the GDSS questionnaire was re-administered at that time. A successful treatment outcome was defined as a patient who was on PPI maintenance therapy or had complete resolution of their acid-related disorder after 12 weeks. Actual and theoretical hospital and community costs of PPI treatment were compared for intervention and comparator patients.

Results

Sixty-three patients were deemed suitable for inclusion in the study. Nineteen patients had their PPI changed from omeprazole to lansoprazole, 16 were initiated on lansoprazole and 28 patients acted as comparators. Of these, one patient was lost to follow-up, while seven patients were eliminated from the study due to non-adherence to the study protocol by either the GP or the patient. There were no significant differences in each of these patient groups in terms of age, sex distribution, readmission rates or GDSS scores at start and end of the study. Decision Tree Analysis was used to demonstrate the treatment success or failure in the final group of patients. Those initiated on lansoprazole 15mg or 30mg had treatment success rates of 100% and 90% respectively, while those changed to lansoprazole from omeprazole had a treatment success of 73%. Comparator patients taking omeprazole 10mg (n=3), 20mg (n=14) or 40mg (n=2) daily had a treatment success rate of 82.6%. This was not significantly different to the total treatment success rate of the intervention patients (90.8% vs. 82.6%, p=0.6). Actual and theoretical hospital and community costs of the intervention groups were significantly less than that of the comparators for all analyses performed (p£0.001).

Discussion

It can be concluded that switching patients to an appropriate less-expensive PPI in the hospital setting can impact significantly on cost-savings in both secondary and primary care.

References

1. Cooper, A., Langworthy, H., Porter, S. (2000). Cost-effective prescribing of proton pump inhibitor therapy: an audit in general practice. International Journal of Clinical Practice; 54(5):287-292.

2. Dott, A. & Johnson, L. (1999). Rational prescribing: Practice audit and drug switch in dyspepsia management. International Journal of Clinical Practice; 53(8):599-603.