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3.5 Proton Pump Inhibitors (Ppis)

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3.5 Proton Pump Inhibitors (Ppis) The ever increasing use of acid suppressive therapy Christian Berg Master of Public Health MPH 2007:10 Nordic School of Public Health The ever increasing use of acid suppressive therapy. Descriptive analysis of data from the national wholesale and prescription databases on the consumption of proton pump inhibitor in Norway. © Nordic School of Public Health ISSN 1104-5701 ISBN 978-91-85721-14-6 MPH 2007:10 Dnr U12/03:179 Master of Public Health – Uppsats – Uppsatsens titel och undertitel The ever increasing use of acid suppressive therapy Descriptive analysis of data from the national wholesale and prescription databases on the consumption of proton pump inhibitor in Norway. Författare Christian Berg Författarens befattning och adress Seniorrådgiver, Divisjon for epidemiologi, Folkehelseinstituttet, Norge Datum då uppsatsen godkändes Handledare NHV/extern 2007-06-08 Cecilia Stålsby Lundborg/Kari Furu Antal sidor Språk – uppsats Språk – sammanfattning ISSN-nummer ISBN-nummer 42 English Norsk 1104-5701 978-91-85721-14-6 Sammanfattning Farmakoepidemiologiske analyser er nødvendige som bakgrunn for å evaluere legemiddelbruk og gjøre kostnads-effektivitets prioriteringer. Databaser med informasjon om salg og forskrivning av legemidler er nyttige redskaper for slike analyser. I denne oppgaven presenteres en analyse av salgs- og forskrivningsdata for protonpumpehemmere, en legemiddelgruppe som brukes ved syrerelaterte gasterointestinale sykdommer. Forbruket av protonpumpehemmere i Norge har siden 1996 økt med 10 % per år, med esomeprazol som vanligste legemiddel. Et økende antall personer bruker disse legemidlene. Utgiftene for det offentlige trygdesystemet er omfattende, mer enn 450 millioner NOK i 2006. Verifisert spiserørbetennelse er den dominerende årsak til forskrivning angitt på reseptene. Det er indikasjoner på en for høy forskrivning av protonpumpehemmere. Forskrivningen i Norge er forskjellig fra Danmark og Sverige, både med hensyn på valg av legemiddel og forbruksnivå. Prevalens for bruk av protonpumpehemmere øker med alder og når et maksimum på nær 12 % av befolkningen i aldersgruppene 70-79 og 80-89 år. En betydelig andel bruker legemidlene over lengre tid (> 2 år). Dette er grupper som bruker mange legemidler samtidig (polyfarmasi). Selv om protonpumpehemmerne har vært på markedet i mange år, diskuteres fortsatt negative følger av langtidsbruk og det er behov for å studere bruken nærmere. Oppmerksomheten bør rettes mot rasjonell bruk av disse legemidlene, ikke bare hvordan utgiftene til dem skal kunne reduseres. Nyckelord Farmakoepidemiologi, registerstudier, reseptstatistikk, protonpumpehemmere Nordiska högskolan för folkhälsovetenskap Box 12133, SE-402 42 Göteborg Tel: +46 (0)31 693900, Fax: +46 (0)31 691777, E-post: [email protected] www.nhv.se MPH 2007:10 Dnr U12/03:179 Master of Public Health – Essay – Title and subtitle of the essay The ever increasing use of acid suppressive therapy Descriptive analysis of data from the national wholesale and prescriptions database on the consumption of proton pump inhibitor in Norway. Author Christian Berg Author's position and address Senior Advisor, Department of epidemiology, Norwegian Institute of Public Health Date of approval Supervisor NHV/External 2007-06-08 Cecilia Stålsby Lundborg/Kari Furu No of pages Language – essay Language – abstract ISSN-no ISBN-no 42 English English 1104-5701 978-91-85721-14-6 Abstract Pharmacoepidemiological analyses are needed as a background for evaluation of drug use and for making cost-effective priorities. Drug sales and prescription databases provide useful tools for analysis of drug consumption and expenditures. In this essay, an analysis of the sales and prescribing of proton pump inhibitors (PPIs), drugs used for acid related gastric disorders, are presented. Since 1996, the consumption of PPIs in Norway has increased by approximately 10 % per year, with esomeprazole as the most commonly used drug. An increasing number of individuals are using these drugs with considerable costs for the reimbursement schemes, e.g., in 2006 more than 450 million NOK. Verified reflux oesophagitis is the predominant indication for reimbursement prescribing. There are, however, indications of an overprescribing of PPIs. The prescribing in Norway is different from Denmark and Sweden, both regarding choice of drug and level of consumption. The prevalence of PPI use increased with age, reaching a maximum of nearly 12 % in the age groups 70-79 and 80-89 years of age. A considerable proportion is long-term users (> 2 years). These groups have a high risk of polypharmacy treatment. Even though the PPIs have been on the market for many years, negative effects associated with long term use are being discussed and need to be further explored. Attention should be focused on the rational use of PPIs and not only on the reduction of costs for PPI therapy. Key words Pharmacoepidemiology, register studies, prescription statistics, PPIs Nordic School of Public Health P.O. Box 12133, SE-402 42 Göteborg Phone: +46 (0)31 693900, Fax: +46 (0)31 691777, E-mail: [email protected] www.nhv.se Table of contents 1 INTRODUCTION ..................................................................................................... 3 2 OBJECTIVES ............................................................................................................ 3 3 BACKGROUND ........................................................................................................ 4 3.1 The reimbursement system in Norway............................................................... 4 3.2 The Anatomical Therapeutic Chemical (ATC) and Defined Daily Dose (DDD) methodology ....................................................................................................... 6 3.2.1 ATC ...................................................................................................... 7 3.2.2 DDD ..................................................................................................... 8 3.3 Data sources on drug utilisation for pharmacoepidemiological research........... 8 3.3.1 The NorDWD ....................................................................................... 9 3.3.2 The NorPD.......................................................................................... 10 3.3.3 Other drug databases in the Nordic countries..................................... 11 3.4 Epidemiology and treatment of GORD, dyspepsia and gastric ulcers ............. 12 3.4.1 Dyspepsia ........................................................................................... 12 3.4.2 Gastro oesophageal reflux disease (GORD)....................................... 12 3.4.3 Gastric ulcers...................................................................................... 13 3.5 Proton Pump Inhibitors (PPIs).......................................................................... 13 3.5.1 Pharmacotherapy ................................................................................ 14 3.5.2 The different PPIs............................................................................... 14 3.5.3 Rational use ........................................................................................ 15 3.5.4 Conditions and criteria for reimbursement of PPIs in Norway .......... 15 4 MATERIAL AND METHODS .............................................................................. 17 4.1 The NorDWD ................................................................................................... 17 4.2 Drug wholesale data from Denmark and Sweden ............................................ 18 4.3 The NorPD........................................................................................................ 18 5 RESULTS ................................................................................................................. 20 5.1 Results from the NorDWD............................................................................... 20 5.1.1 Development of the consumption of PPIs measured in DDD/1000 inhabitants/day.................................................................................... 20 5.1.2 Development of sales measured in NOK ........................................... 21 5.1.3 Development of prices per DDD........................................................ 22 5.1.4 Market share of different tablet strengths 2006.................................. 23 5.2 Development of the consumption of PPIs in Denmark and Sweden................ 24 5.3 Results from the NorPD: .................................................................................. 26 5.3.1 Prevalence of PPI use 2006 ................................................................ 26 5.3.2 Incidence of PPI use 2006 .................................................................. 29 5.3.3 Long-term users.................................................................................. 31 5.3.4 Adherence to therapy (number of days covered by a DDD) .............. 32 5.3.5 Indications for reimbursement............................................................ 33 6 DISCUSSION........................................................................................................... 34 7 CONCLUSIONS ...................................................................................................... 38 1 INTRODUCTION It is recognised that the resources available to meet health care needs are limited. The Norwegian health authorities aim to use the allocated funds for health services as cost-
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