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PREVALENCE OF HIGH-INTENSITY PROTON PUMP INHIBITOR USE IN MANITOBA: A POPULATION-BASED ANALYSIS

LE Targownik, C Metge, S Leung
Depts. of Gastroenterology and Pharmacy, Univ. of Manitoba, Winnipeg, Manitoba

INTRODUCTION: Proton pump inhibitors (PPIs) are among the most commonly prescribed drugs in North America. While PPIs are often recommended to be used at standard doses, previous studies have suggested up to 30% of PPI users are prescribed higher than standard doses, despite limited evidence of the efficacy of high-dose PPIs. Therefore, we sought to determine the prevalence of high intensity PPI use and to describe the characteristics of high-intensity users.
METHODS: We used Manitoba's provincial health care database to identify all Manitobans who filled at least one prescription for a PPI between 1996 and 2004. We determined the intensity of PPI use for each PPI prescription by dividing the number of pills dispensed by the number of days between dispensations. We categorized each enrollee's contributed PPI use time as either high-intensity or standard-intensity use dependent on whether the intensity of use was above or below 1.5 standard doses of PPI/day for a particular dispensation. A person was considered to be a long-term PPI user if they had at least 360 days of PPI use at any intensity, and was considered a high-intensity user if at least 50% of PPI use was categorized as high intensity. We compared age, sex, burden of comorbid illness, socioeconomic status, history of upper GI events and of endoscopic investigations between high-intensity and standard-intensity PPI users. The burden of comorbid illness was determined by enumerating the number of unique aggregated diagnostic groups (ADGs) for which the enrollee received care in the year before the initial PPI prescription.
RESULTS: Of 825,429 enrollees, we identified 117,201 individuals who had filled at least one prescription for a PPI, of whom 36,104 (30.8%) had used PPIs for at least 360 days during the study period. Seven point seven per cent of long-term PPI users could be classified as high-intensity users (³50% of all PPI use time at high intensity). High-intensity PPI users were of similar age to standard intensity users (64.9 yrs. vs 65.1 yrs) and the groups had a similar percentage of females (61.2% vs 60.0%). High intensity PPI users had a higher burden of comorbid illnesses (5.2 ADGs vs 4.4 ADGs, P<0.001), and had poorer socioeconomic status. High-intensity PPI users were more likely to have been admitted to hospital for an upper GI complication (9.4% vs 6.1%) and to have received upper endoscopy (39.0% vs 29.9%).
CONCLUSIONS: The prevalence of long-term high-intensity PPI use is lower than previously reported, though high-intensity PPI users appear to be more ill and more likely to undergo costly investigations. We intend to perform further analyses with this comprehensive database to characterize the population of high-intensity PPI users and to gain further insights into the clinical and economic outcomes associated with high-intensity PPI use.

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