Brief Article
Copyright ©2010 Baishideng. All rights reserved.
World J Gastroenterol. Feb 28, 2010; 16(8): 982-986
Published online Feb 28, 2010. doi: 10.3748/wjg.v16.i8.982
Clinical and cost impact of intravenous proton pump inhibitor use in non-ICU patients
Soumana C Nasser, Jeanette G Nassif, Hani I Dimassi
Soumana C Nasser, Jeanette G Nassif, Hani I Dimassi, Department of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos Campus, PO Box 36, 13-5053 Beirut, Lebanon
Author contributions: Nasser SC designed the trial, contributed in data collection and entry, analyzed and interpreted the data, wrote and critically revised the manuscript; Nassif JG helped in designing the trial, reviewed the literature, wrote and critically revised the manuscript; Dimassi HI conducted the statistical analysis, interpreted the data and reviewed the manuscript.
Correspondence to: Soumana C Nasser, Pharm. D, Clinical Assistant Professor, Department of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos Campus, PO Box 36, 13-5053 Beirut, Lebanon. soumana.nasser@lau.edu.lb
Telephone: +961-3-489860 Fax: +961-9-547256
Received: November 6, 2009
Revised: December 14, 2009
Accepted: December 21, 2009
Published online: February 28, 2010
Abstract

AIM: To assess the appropriateness of the indication and route of administration of proton-pump-inhibitors (PPIs) and their associated cost impact.

METHODS: Data collection was performed prospectively during a 6-mo period on 340 patients who received omeprazole intravenously during their hospital stay in non-intensive care floors. Updated guidelines were used to assess the appropriateness of the indication and route of administration.

RESULTS: Complete data collection was available for 286 patients which were used to assess intravenous (IV) PPIs utilization. Around 88% of patients were receiving PPIs for claimed stress ulcer prophylaxis (SUP) indication; of which, only 17% met the guideline criteria for SUP indication, 14% met the criteria for non-steroidal-anti-inflammatory drugs-induced ulcer prophylaxis, while the remaining 69% were identified as having an unjustified indication for PPI use. The initiation of IV PPIs was appropriate in 55% of patients. Half of these patients were candidates for switching to the oral dosage form during their hospitalization, while only 36.7% of these patients were actually switched. The inappropriate initiation of PPIs via the IV route was more likely to take place on the medical floor than the surgical floor (53% vs 36%, P = 0.003). The cost analysis associated with the appropriateness of the indication for PPI use as well as the route of administration of PPI revealed a possible saving of up to $17 732.5 and $14 571, respectively.

CONCLUSION: This study highlights the over-utilization of IV PPIs in non-intensive care unit patients. Restriction of IV PPI use for justified indications and route of administration is recommended.

Keywords: Cost saving; Lebanon; Non-intensive care unit patients; Omeprazole; Over-utilization; Proton-pump-inhibitors; Stress ulcer prophylaxis