title: Proton pump inhibitors: potential cost reductions by applying prescribing guidelines.
abstract: BACKGROUND
  There are concerns that proton pump inhibitors (PPI) are being over prescribed in both primary and secondary care. This study aims to establish potential cost savings in a community drug scheme for a one year period according to published clinical and cost-effective guidelines for PPI prescribing.
  
  
  METHODS
  Retrospective population-based cohort study in the Republic of Ireland using the Health Services Executive (HSE) Primary Care Reimbursement Services (PCRS) pharmacy claims database. The HSE-PCRS scheme is means tested and provides free health care including medications to approximately 30% of the Irish population. Prescription items are WHO ATC coded and details of every drug dispensed and claimants' demographic data are available. Potential cost savings (net ingredient cost) were estimated according to UK NICE clinical guidelines for all HSE-PCRS claimants on PPI therapy for ≥3 consecutive months starting in 2007 with a one year follow up (n=167,747). Five scenarios were evaluated; (i) change to PPI initiation (cheapest brand); and after 3 months (ii) therapeutic switching (cheaper brand/generic equivalent); (iii) dose reduction (maintenance therapy); (iv) therapeutic switching and dose reduction and (v) therapeutic substitution (H2 antagonist).
  
  
  RESULTS
  Total net ingredient cost was €88,153,174 for claimants on PPI therapy during 2007. The estimated costing savings for each of the five scenarios in a one year period were: (i) €36,943,348 (42% reduction); (ii) €29,568,475 (34%); (iii) €21,289,322 (24%); (iv) €40,505,013 (46%); (v) €34,991,569 (40%).
  
  
  CONCLUSIONS
  There are opportunities for substantial cost savings in relation to PPI prescribing if implementation of clinical guidelines in terms of generic substitution and step-down therapy is implemented on a national basis.
authors.affiliation: HRB Centre for Primary Care Research, Division of Population Health Science, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland. caitrionacahir@rcsi.ie
authors.forename: Caitriona
authors.initials: C
authors.lastname: Cahir
authors.forename: Tom
authors.initials: T
authors.lastname: Fahey
authors.forename: Lesley
authors.initials: L
authors.lastname: Tilson
authors.forename: Conor
authors.initials: C
authors.lastname: Teljeur
authors.forename: Kathleen
authors.initials: K
authors.lastname: Bennett
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017046:Cost Savings / Q000191:economics / Q000379:methods; D016208:Databases, Factual; D016527:Drug Costs; D057915:Drug Substitution / Q000191:economics / Q000592:standards; D005260:Female; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors