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Lookup NU author(s): Emeritus Professor Greg RubinORCiD
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Background. Proton pump inhibitors (PPIs) constitute the largest sector of the National Health Service (NHS) community drugs bill (pound 238m; 5.6%). Little is known of the longterm prescribing component of this. Aim. To study the extent, the reasons for, and the cost implications of the long-term prescription of PPIs in general practice. Method. Subjects on long-term therapy were identified by searches of computerized and paper records from three practices, comprising 21 GPs with 46 650 patients, representing a population cross section in north-east England. Results. Two hundred and nine (0.45%) patients were on long-term PPIs (range between practices = 0.3% to 0.55%): 87% were on omeprazole, 13% lansoprazole; average age = 60 years (male = 56 years, female = 64 years; range = 14 to 91 years); male to female ratio = 47:53. The main indications were 'reflux' (39%), 'oesophagitis' (17%), non-specified 'dyspepsia' (24%), 'peptic ulcer' (8%). During the study year, 1952 prescriptions (28-day courses) were issued: a mean of nine per patient (range = 1 to 8). Sixteen per cent of patients requested fewer than six prescriptions, 27% requested between six and nine prescriptions, and only 21% requested sufficient prescriptions for the entire year. The average cost was pound 3707 per general practitioner per annum, or pound 320 000 for the district, representing 40% of the total PPI bill. Conclusion. Of the total population, 0.45% were prescribed long-term PPIs; most for symptom relief. The long-term component comprised 40% of all PPI costs estimated at pound 100 million per annum for the United Kingdom. Most patients took their treatment only intermittently. More research is needed into strategies for rationalization of long-term PPI therapy. For most patients, doctors can advise on-demand rather than regular once-daily therapy.
Author(s): Hungin APS, Rubin GP, O'Flanagan H
Publication type: Article
Publication status: Published
Journal: British Journal of General Practice
Year: 1999
Volume: 49
Issue: 443
Pages: 451-453
Print publication date: 01/06/1999
ISSN (print): 0960-1643
ISSN (electronic): 1478-5242
Publisher: Royal College of General Practitioners
