Healthy Skepticism Library item: 10644

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Publication type: Journal Article

Lucioni C, Mazzi S.
Prescription practice versus consuption standards with reference to proton pump inhibitors in Italy
PharmacoEconomics - Italian Research Articles 2003; 5:(1):3-10

Abstract:

Objectives: To assess the consumption levels of proton pump inhibitors (PPIs) in Italy, in comparison with some foreign markets. To investigate the practice in PPI prescribing in Italy, in comparison with consumption standards. Design: The DDD (Defined Daily Dose) tool was adopted as the best unit of measure to be used in fulfilling the first objective. With regard to the second objective, in order to estimate the PDDs (Prescribed Daily Doses) in the PPI area, a large sample (8940 prescription episodes) was drawn from the Health Search database, a facility created by Societa Italiana di Medicina Generale and supported by a number of pharmaceutical companies. Results: The Italian PPI market size was 198.2 million DDDs in 2000 (more than twice the 1995 data), corresponding to 9.4 DDDs per 1000 people per day (that is, about 1% of the Italian population is treated every day with PPIs). In the same year, PPI consumption was 16.5 DDDs per 1000 people per day in France and 19.3 in the UK. In Italy, the ratio between PPI and H2-antagonists consumption (1.6) was lowest, as compared with France (4.5) and with UK (1.8). With regard to omeprazole, the prescription practice (weighted average PDD: 25.4 mg) was higher than its standard (DDD: 20 mg); similar results were found for pantoprazole (46 vs 40 mg) and rabeprazole (22.2 vs 20 mg). On the contrary, lansoprazole’s PDD (23.4 mg) was lower than its DDD (30 mg); however, the average length of therapy with lansoprazole turned out to be longer. Conclusions: The PPI market is expanding in Italy, although to a lesser extent and with more competition from H2-antagonists as compared with France and the UK. When evaluating prescription practices and their costs, the DDD tool has clear limitations, while PDD is a better measure. However, not only PDD amounts but also lengths of therapies should be taken into consideration in order to formulate sound judgements about treatment costs.