Prescribing proton pump inhibitors for initial treatment of acid-related gastrointestinal diseases in a managed care population.
OBJECTIVE
To determine whether health services use by patients with selected acid-related gastrointestinal disorders (peptic ulcer disease, gastroesophageal reflux disease, and gastritis or dyspepsia) is lower after initial treatment with proton pump inhibitors (PPIs) than with histamine2 receptor antagonists (H2RAs).


METHODS
Retrospective, 2-year longitudinal study.


METHODS
Among continuous enrollees from December 1, 1996, to June 1, 2002, in a group model health maintenance organization, 13,971 members were electronically selected who began receiving antisecretory therapy during that period and who had no previous drug therapy, endoscopy, or hospitalization for gastrointestinal disease. Adjusted medical costs and healthcare use related to gastrointestinal disease (measured by office visits, endoscopy, or imaging and hospital admissions) and factors associated with initial and subsequent drug therapy were analyzed using a 2-stage model. This method adjusted for unobservable confounders, primarily drug selection bias, an inherent limitation of retrospective database studies.


RESULTS
Drug costs were more than 4-fold higher (P < .001) when PPIs rather than H2RAs were prescribed initially, but non-drug costs and health services use showed no decrease. A history of physicians' prescribing PPIs in the prior 12 months was associated with prescribing PPIs as initial therapy (odds ratio, 4.29; 95% confidence interval, 3.74-4.90) and with step-up therapy (change from H2RAs to PPIs). A history of physicians' prescribing H2RAs in the prior 12 months was associated with step-down therapy (change from PPIs to H2RAs).


CONCLUSIONS
Prescribing PPI compared with H2RA therapy as initial therapy for acid-related gastrointestinal disease produced no decrease in nondrug costs or health services use.
Pharmacy Outcomes Research Group, Pharmacy Operations, Kaiser Permanente Medical Care Program, Oakland, Calif 94612, USA. jim.chan@kp.org
James
J
Chan
Rita L
RL
Hui
Jean-Luc
JL
Szpakowski
D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005744:Gastric Acid / Q000502:physiology*; D005767:Gastrointestinal Diseases / Q000145:classification / Q000188:drug therapy*; D006302:Health Services Research; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D054328:Proton Pump Inhibitors; D014481:United States
D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors