Gli Inibitori della Pompa Protonica: uno studio di drug utilization, con particolare riferimento all’appropriatezza del loro uso nella gastroprotezione

Autor: S. Mazzi, C. Cerra, C. Lucioni, Pietro Fratino
Rok vydání: 2007
Předmět:
Zdroj: PharmacoEconomics Italian Research Articles. 9:75-89
ISSN: 2035-6137
1590-9158
DOI: 10.1007/bf03320702
Popis: Protonic Pump Inhibitors (PPIs) are an innovative class of drugs, effective in the treatment of gastrointestinal acid-related diseases — including those induced by the use of nonsteroidal anti-inflammatory drugs (NSAIDs). With reference to PPIs, the present study was aimed at assessing consumption trends, empirical dosages versus therapeutic appropriateness in gastroprotection, and the impact of their use on hospitalisations. Data for this (retrospective) study were available in the administrative database of a middle-sized (half a million beneficiaries) Local Health Unit in Northern Italy. A sample was built by selecting all patients who, between 2000 and 2005, had been hospitalised due to a gastroduodenal ulcer and/or had received at least one prescription for NSAIDs and/or for PPIs. Therapeutic appropriateness (the combined result of two separate compliances: the doctor’s and the patient’s) in PPIs use face to NSAIDs was evaluated both by comparing estimated RDDs (Received Daily Doses) and PDDs (Prescribed Daily Doses) with the respective DDDs (Defined Daily Doses) and by using more specific tools, such as the ratio of co-prescriptions (simultaneous prescriptions for NSAIDs and PPIs, as indicators of willingness to treat for gastroprotection) to all prescriptions of NSAIDs. The original sample consisted of 95,716 patients (mean age: 58 years, 45% males). Treatment with PPIs resulted to be largely occasional: about half of the patients had been treated no longer than one year and just as many had received no more than one prescription per year. Consumption of, and expenditure for, PPIs was rising through the whole observation period, substantially due to the increasing number of treated patients. The general, weighted relative RDD mean was scarcely above 40% of the DDD. The ratio of co-prescriptions to all prescriptions of NSAIDs showed a positive trend and reached 50% in the sub-sample of strictly treated patients, in 2004. Among patients with at least one co-prescription per year, the probability of being hospitalised was significantly lower than among patients with no or less than one per year co-prescriptions. Administrative databases are being more and more frequently used as a statistical source to conduct studies in pharmacoeconomic evaluation as well as in drug utilization. Based on data from a Health Unit located in Northern Italy, an extended analysis was performed mainly focused on the use of PPIs in a gastroprotection perspective. Results were interesting and the impact of gastroprotection in containing the hospitalisation risk was assessed. A crucial limitation in this study is due to the fact that patient records in the database were not marked with a severity of disease indicator; so the sample could not be broken down by severity — which might have instead helped to capture more clearly the above mentioned impact. A possible continuation of the study should therefore address the problem of providing severity indicators.
Databáze: OpenAIRE
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