Marked increase in proton pump inhibitors use in Australia

Authors

  • Samantha Hollingworth,

    Corresponding author
    1. The University of Queensland, School of Population Health, Herston Road, Herston Australia
    • School of Population Health, University of Queensland Herston Road, Herston QLD 4006, Australia.
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  • Emma L Duncan,

    1. The University of Queensland, Diamantina Institute for Cancer, Immunology and Metabolic Medicine, Princess Alexandra Hospital, Australia
    2. The University of Queensland, School of Medicine, Princess Alexandra Hospital, Woolloongabba, Australia
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    • Staff Specialist, Department of Endocrinology, Princess Alexandra Hospital, Woolloongabba, Australia.

  • Jennifer H Martin

    1. The University of Queensland, Diamantina Institute for Cancer, Immunology and Metabolic Medicine, Princess Alexandra Hospital, Australia
    2. The University of Queensland, School of Medicine, Princess Alexandra Hospital, Woolloongabba, Australia
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    • Head, Southern Clinical School and Clinical Pharmacologist, The University of Queensland School of Medicine, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Queensland, Australia 4102.


  • There were no conflicts of interest. No ethics approval was required for this study.

Abstract

Objectives

To examine the trends in the prescribing of subsidised proton pump inhibitors (PPIs) and histamine receptor antagonists (H2RAs), in the Australian population from 1995 to 2006 to encourage discussion regarding appropriate clinical use. PPIs and H2RAs are the second highest drug cost to the publicly subsidised Pharmaceutical Benefits Scheme (PBS).

Design

Government data on numbers of subsidised scripts, quantity and doses for PPIs and H2RAs were analysed by gender and age, dose and indication.

Main outcome measure

Drug utilisation as DDD [defined daily dose]/1000 population/day.

Results

The use of combined PPIs increased by 1318%. Utilisation increased substantially after the relaxation of the subsidised indications for PPIs in 2001. Omeprazole had the largest market share but was substituted by its S-enantiomer esomeprazole after its introduction in 2002. There was considerable use in the elderly with the peak use being in those aged 80 years and over. The utilisation of H2RAs declined 72% over 12 years.

Conclusions

PPI use has increased substantially, not only due to substitution of H2RAs but to expansion in the overall market. Utilisation does not appear to be commensurate with prevalence of gastro-oesophageal reflux disease (GORD) nor with prescribing guidelines for PPIs, with significant financial costs to patients and PBS. This study encourages clinical discussion regarding quality use of these medicines. Copyright © 2010 John Wiley & Sons, Ltd.

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