title: Potential costs of inappropriate use of proton pump inhibitors.
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.
authors.affiliation: Division of Gastroenterology (AML), Department of Medicine (JC, NM, RG), Department of Internal Medicine, Lenox Hill Hospital (GP), New York, New York.
authors.forename: Antonio Mendoza
authors.initials: AM
authors.lastname: Ladd
authors.forename: Georgia
authors.initials: G
authors.lastname: Panagopoulos
authors.forename: Joshua
authors.initials: J
authors.lastname: Cohen
authors.forename: Nataliya
authors.initials: N
authors.lastname: Mar
authors.forename: Robert
authors.initials: R
authors.lastname: Graham
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D064098:Esomeprazole / Q000009:adverse effects / Q000191:economics*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000191:economics; D006760:Hospitalization / Q000191:economics; D006801:Humans; D057970:Inappropriate Prescribing / Q000009:adverse effects / Q000191:economics*; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000191:economics*; D012189:Retrospective Studies
chemical_list: D054328:Proton Pump Inhibitors; D064098:Esomeprazole