ABSTRACT
Title
Prescription of proton pump inhibitor during 2006-2009 in Campania region
Authors
E. Tragni1 , M. Casula1, S. Riegler2, C.M. Desogus1, M. Gentili1, S. Cammarota2, A. Citarella2, E. Menditto2, E. Novellino2, A.L. Catapano1
1-Centro Interuniversitario di Epidemiologia e Farmacologia Preventiva (SEFAP), University of Milan
2-Centro Interdipartimentale di Ricerca in Farmacoeconomia e Farmacoutilizzazione (CIRFF), University of Naples
1-Centro Interuniversitario di Epidemiologia e Farmacologia Preventiva (SEFAP), University of Milan
2-Centro Interdipartimentale di Ricerca in Farmacoeconomia e Farmacoutilizzazione (CIRFF), University of Naples
Abstract
Background Proton pump inhibitors(PPIs) are a group of drugs whose main action is a pronounced and long-lasting reduction of gastric acid production. PPIs are one of the most frequently prescribed drugs in the world
Objectives The aim of this study was to describe the PPIs use profile in primary care, also by gender and age, and the trends in utilisation and related expenditure in Campania, an Italian Regions of almost 5.5 million inhabitants, from January 2006 to December 2009.
Methods We conducted a retrospective cohort study of the 2006-2009 Campania outpatient pharmacy databases (containing prescription of class A-SSN drugs of all Local Health Units [LHU] in the region) of Campania residents aged ≥6 and <=95 years. Based on the ATC classification system, drugs belonging to A02BC (PPIs), reimbursed under "Nota 1" and "Nota 48", were considered in the analysis. The cohort comprised subjects who had at least one prescription filled and dispensed of these drugs during each of the study years (current users). Prevalence was defined as the number of current users with at least one prescription of one or more PPIs during each year of investigation divided by the total ISTAT number of inhabitants in that year of investigation. Incidence was defined as the number of new users (those with no prescriptions of PPIs in the previous year) with at least one prescription of one or more PPIs during each year of investigation divided by the total ISTAT number of inhabitants in that year of investigation.
The amount of drug dispensed was standardised using DDD/1000 population day. We also determined total and per capita expenditures. All data were stratified by age, sex, PPI active molecule and LHUs. We also assessed the proportion of prevalent and incident amounts of unbranded equivalent drugs prescribed per year and the shift from branded and unbranded drugs and vice versa.
Results We identified 662,792 (2006), 799,476 (2007), 960,375 (2008) and 1,008,864 (2009) current users of PPI. M/F rates were 0.84 (2006), 0.83 (2007), 0.80 (2008) and 0.79 (2009) vs 0.94 for Campania inhabitants. A greater use of PPI was present in women. The mean age was 60ys in all observed years. The amount of total prescriptions was about 2,5 million in 2006, rising to about 5 million in 2009, with an increased mean (±SD) of the prescriptions/users from 3.9±4.4 in 2006 to 5.0±5.0 in 2009.
Prevalence of PPI use increased during the follow-up, from 12.7% in 2006 to 19.2% in 2009, with a delta of 51.2%. On the contrary, incidence decreased by 8.3% from 2007 to 2008 and by 6.3% from 2008 to 2009, with a delta of -24.0%. The rates between incident/prevalent users were 0.56 in 2007, 0.44 in 2008 and 0.34 in 2009.
The utilization pattern was quite complex, due to the marketing of generics for lansoprazole, omeprazole, and pantoprazole, and to the release of a regional guideline aimed at containing health care costs.
PPI consumptions increased in 2006-2009 period (23.5 DDD/1000 population day in 2006 vs 46.6 DDD/1000 population day in 2009), was higher in women and in older age users. Lansoprazole and omeprazole were the most prescribed products, with the latter showing a clear increasing trend, especially between 2008 and 2009. Esomeprazole consumption showed a strong decrease from 2008 to 2009. Rabeprazole, with more restricted label, was the less prescribed drug. Total expenditure for PPIs decreased during observation period (€ 44,679,735 in 2006 vs € 39,189,463 in 2009; delta -12.3%), as well as for per capita costs (delta -42.4%). There was a clear escalation of the generics use up to 21.7% in 2009, higher in the older users and similar for both genders.
Conclusion This pharmacoutilization study confirmed the national data from Osmed on PPIs use and provided an extensive description of user characteristics.
Objectives The aim of this study was to describe the PPIs use profile in primary care, also by gender and age, and the trends in utilisation and related expenditure in Campania, an Italian Regions of almost 5.5 million inhabitants, from January 2006 to December 2009.
Methods We conducted a retrospective cohort study of the 2006-2009 Campania outpatient pharmacy databases (containing prescription of class A-SSN drugs of all Local Health Units [LHU] in the region) of Campania residents aged ≥6 and <=95 years. Based on the ATC classification system, drugs belonging to A02BC (PPIs), reimbursed under "Nota 1" and "Nota 48", were considered in the analysis. The cohort comprised subjects who had at least one prescription filled and dispensed of these drugs during each of the study years (current users). Prevalence was defined as the number of current users with at least one prescription of one or more PPIs during each year of investigation divided by the total ISTAT number of inhabitants in that year of investigation. Incidence was defined as the number of new users (those with no prescriptions of PPIs in the previous year) with at least one prescription of one or more PPIs during each year of investigation divided by the total ISTAT number of inhabitants in that year of investigation.
The amount of drug dispensed was standardised using DDD/1000 population day. We also determined total and per capita expenditures. All data were stratified by age, sex, PPI active molecule and LHUs. We also assessed the proportion of prevalent and incident amounts of unbranded equivalent drugs prescribed per year and the shift from branded and unbranded drugs and vice versa.
Results We identified 662,792 (2006), 799,476 (2007), 960,375 (2008) and 1,008,864 (2009) current users of PPI. M/F rates were 0.84 (2006), 0.83 (2007), 0.80 (2008) and 0.79 (2009) vs 0.94 for Campania inhabitants. A greater use of PPI was present in women. The mean age was 60ys in all observed years. The amount of total prescriptions was about 2,5 million in 2006, rising to about 5 million in 2009, with an increased mean (±SD) of the prescriptions/users from 3.9±4.4 in 2006 to 5.0±5.0 in 2009.
Prevalence of PPI use increased during the follow-up, from 12.7% in 2006 to 19.2% in 2009, with a delta of 51.2%. On the contrary, incidence decreased by 8.3% from 2007 to 2008 and by 6.3% from 2008 to 2009, with a delta of -24.0%. The rates between incident/prevalent users were 0.56 in 2007, 0.44 in 2008 and 0.34 in 2009.
The utilization pattern was quite complex, due to the marketing of generics for lansoprazole, omeprazole, and pantoprazole, and to the release of a regional guideline aimed at containing health care costs.
PPI consumptions increased in 2006-2009 period (23.5 DDD/1000 population day in 2006 vs 46.6 DDD/1000 population day in 2009), was higher in women and in older age users. Lansoprazole and omeprazole were the most prescribed products, with the latter showing a clear increasing trend, especially between 2008 and 2009. Esomeprazole consumption showed a strong decrease from 2008 to 2009. Rabeprazole, with more restricted label, was the less prescribed drug. Total expenditure for PPIs decreased during observation period (€ 44,679,735 in 2006 vs € 39,189,463 in 2009; delta -12.3%), as well as for per capita costs (delta -42.4%). There was a clear escalation of the generics use up to 21.7% in 2009, higher in the older users and similar for both genders.
Conclusion This pharmacoutilization study confirmed the national data from Osmed on PPIs use and provided an extensive description of user characteristics.