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139 COMPARING DOUBLE DOSE VERSUS STANDARD DOSE PROTON PUMP INHIBITOR THERAPY FOR INITIAL TREATMENT OF UPPER GASTROINTESTINAL SYMPTOMS LE Targownik, CM Metge, S Leung BACKGROUND: Proton pump inhibitors are frequently used in patients presenting with a variety of upper gastrointestinal symptoms. It is unclear whether prescribing a higher dose of PPIs initially is associated with improved clinical and economic outcomes.
Departments of Internal Medicine and Pharmacy, University of Manitoba, Winnipeg, Manitoba
METHODS: We used the Manitoba Health population based province-wide health care utilization database to identify all patients with a new PPI prescription associated with a physician visit for an upper gastrointestinal symptom without a history of gastrointestinal bleeding or previous upper endoscopy. Patients starting PPI therapy for treatment of H pylori were excluded. We then identified all persons with new double-dose PPI prescriptions and matched them to up to 3 controls prescribed a standard dose of PPIs. All controls were matched on age, sex, socioeconomic status, presence of severe comorbid illness, previous GI and non-GI hospital admissions, and prescription date. Cases and controls were followed in the database for 12 months, where use of GI-related inpatient and outpatient resource utilization and prescription drug usage was calculated.
RESULTS: We identified 2339 new double-dose prescriptions which were linked to 5762 tightly-matched standard dose controls. At baseline, double-dose PPI users were more likely to have recently used NSAIDs and H2 receptor antagonists. In the year following initial prescription, there were no differences in overall duration of PPI use between cases and controls (128 vs 126 d, p>0.2), and subjects prescribed double-dose PPIs only ingested PPIs at double doses for a mean of 30 d. Subjects initially prescribed double-dose PPIs had more frequent GI-related ambulatory care visits (2.28 vs 2.01 visits/yr, p<0.001), were more likely to undergo upper endoscopy (22.5% vs 18.5%, p<0.001), and were more likely to be admitted to hospital for upper gastrointestinal tract disease (1.24% vs 0.62%, p=0.015). 12-month GI related costs are higher for subjects initially prescribed double-dose PPIs ($750.52 vs $567.72, p<0.001)
CONCLUSION: Initial therapy with double-dose PPIs does not appear to lead to any reduction in GI-related health care utilization, and may in fact increase the costs of care. Furthermore, patients prescribed double-dose PPIs will often step down to lower doses over time. The practice of prescribing double-dose PPIs as initial therapy for upper gastrointestinal symptoms should be discouraged.