Clinical and cost impact of intravenous proton pump inhibitor use in non-ICU patients

Table 1 Patient characteristics (n = 286)

	n (%)
Age, yr (median ± IQR)	64 ± 30
Weight, kg (median ± IQR)	72 ± 23
Creatinine clearance, mL/min (median ± IQR)	71.5 ± 57.6
Age ≥ 65 yr	143 (51)
Male	149 (52)
Medical floor	146 (51)
Surgical floor	140 (49)
Dose 40 mg omeprazole	272 (95)
Frequency as once daily	251 (88)
Medications
Heparins	133 (47)
NSAIDs	74 (26)
Corticosteroids	74 (26)
Aspirin (100 mg)	42 (15)
Clopidogrel	15 (5)
Acenocoumarol	10 (4)

IQR: Interquartile range; NSAIDs: Non-steroidal-anti-inflammatory drugs.

Table 2 Justification of PPI indications

	n (%)
Out of the total sample (n = 286)
Treatment indications	35 (12)
Claimed as using PPI for SUP indication	251 (88)
Classification of patients claimed as using PPI for SUP indication (n = 251)
Meeting criteria for SUP indication	43 (17)
Meeting criteria for NSAIDs-induced prophylaxis	35 (14)
Age ≥ 65 yr + NSAIDs	12 (5)
NSAIDS + antithrombotics	23 (9)
NSAIDS + corticosteroids	17 (7)
Unjustified prophylactic use	173 (69)
Age ≥ 65 yr	81 (32)
Age ≥ 65 yr + LMWH	55 (22)
Age ≥ 65 yr + antiplatelets	60 (24)
Age ≥ 65 yr + corticosteroids	25 (10)
Others	90 (36)

PPI: Proton-pump-inhibitor; SUP: Stress ulcer prophylaxis.

Table 3 Correlation of initial IV administration with indication and eligibility for oral conversion n (%)

	Appropriate initial IV use	Inappropriate initial IV use	P value
Total IV use (n = 286)	158 (55)	128 (45)
Switched	58 (37)	49 (38)	0.785
Candidate for Switch	82 (52)	127 (99)	< 0.001
Indication
Treatment (35)	22 (14)	13 (10)	0.556
SUP justified (43)	26 (17)	17 (13)	0.556
NSAIDs-induced (justified) (35)	17 (11)	18 (14)	0.556
Other unjustified prophylaxis (173)	93 (59)	80 (63)	0.556
Frequency as once daily	138 (87)	113 (88)	0.81
Dose 40 mg	152 (96)	120 (95)	0.491
Medical floor	68 (47)	78 (53)	0.003
Surgical floor	90 (64)	50 (36)	0.003
Duration of IV use (median ± IQR)	4.0 ± 4.0	4.0 ± 4.0	0.422

IV: Intravenous.

Table 4 Cost analysis for inappropriate route of administration and indication

	Appropriate initial IV PPI use	Inappropriate initial IV PPI use
Candidate for switch	n = 82	n = 128
Cost of 40 mg IV PPI daily dose that could be avoided	$1681	$13 120
Cost of 40 mg PPI oral daily dose (if used instead of IV)	$184	$1434
Cost that could be avoided with the oral use	$1497	$11 686
Total cost that could be avoided with IV to po conversion	$13 183
Cost that could be avoided from	$17 732.5
Unjustified prophylactic use of IV PPI (n = 173)