[General practitioners' management of gastroesophageal reflux in France in 2005: a pharmacoeconomic study].
OBJECTIVE
Proton pump inhibitors (PPIs) rank third among drug classes in the amount they cost the French health care system annually (more than a billion euros, i.e., 5.7% of community pharmaceutical expenditures, 50% prescribed for gastroesophageal reflux disease (GERD)).


METHODS
Data for a representative sample of patients aged 20 years and older, who visited their GP at least once in 2005 for uncomplicated symptomatic GERD came from the Thales database (1200 representative general practitioners (GP) connected to a computerized network) a.


RESULTS
In 2005, 122 571 patients (mean age, 56 years, 45% male, 2.6 consultations for GERD) met the inclusion criteria. Extrapolated to the French population, this sample corresponds to 5.7 million people, i.e., 13% of the adult population who visited a GP during the year. PPIs were prescribed as first-line treatment for GERD in 84% of the consultations. Omeprazole, as a proprietary or generic drug, was prescribed most often (79%) and at a full dose (20mg), while other compounds (lansoprazole, pantoprazole, rabeprazole and esomeprazole) were prescribed at half dose in 64% of cases. The extrapolated annual cost of PPIs reimbursed for this indication was 465 million euros (Meuro) at a mean reimbursement level of 73%. Brand-name omeprazole still accounts for 11% of the total cost reimbursed. Complete replacement of brand-name omeprazole by its generic counterpart would reduce costs by 18.35Meuro (-4.3% reimbursed expenditure). The switch from generic full-dose omeprazole to a half dose of other PPIs would allow a further saving of 2.6 (with lansoprazole) to 13.2 Meuro (with pantoprazole).


CONCLUSIONS
A substantial saving in reimbursed pharmaceutical spending in uncomplicated GERD and full compliance with clinical practice recommendations could be achieved by the substitution of less expensive PPIs.
Mouly
Stéphane
S
Assistance publique-Hôpitaux de Paris, Unité de recherches thérapeutiques, Service de médecine interne A, Hôpital Lariboisière, F-75010 Paris, France. stephane.mouly@lrb.ap-hop-paris.fr
Charlemagne
Agnès
A
Le Jeunne
Philippe
P
Fagnani
Francis
F
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D000897:Anti-Ulcer Agents / Q000191:economics / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D064098:Esomeprazole; D005194:Family Practice; D005260:Female; D005602:France / Q000453:epidemiology; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D006801:Humans; D064747:Lansoprazole; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000191:economics / Q000627:therapeutic use; D000077402:Pantoprazole; D017494:Proton Pumps / Q000191:economics / Q000627:therapeutic use; D064750:Rabeprazole
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D017494:Proton Pumps; D064747:Lansoprazole; D064750:Rabeprazole; D000077402:Pantoprazole; D009853:Omeprazole; D064098:Esomeprazole