Who gets prescriptions for proton pump inhibitors and why? A drug-utilization study with claims data in Bavaria, Germany, 2010-2018

Abstract

Purpose: The German annual drug prescription-report has indicated overuse of proton pump inhibitors (PPIs) for many years; however, little was known about the characteristics of people using PPIs. This study aimed to provide comprehensive utilization data and describe frequencies of potential on- and off-label PPI-indications in Bavaria, Germany.

Methods: Claims data of statutorily insured people from 2010 to 2018 were used. Defined daily doses (DDDs) of PPIs by type of drug, prevalence of PPI-use and DDDs prescribed per 1000 insured people/day were analyzed. For 2018, proportions of users and DDDs per 1000 insured people were calculated by age and sex. To elucidate changes in prescribing practices due to a suspected drug-drug interaction, we examined co-prescribing of clopidogrel and PPIs between 2010 and 2018. For PPI new users, sums of DDDs and frequencies of potential indications were examined.

Results: PPI prescribing increased linearly from 2010 to 2016 and gradually decreased from 2016 to 2018. In 2018, 14.7% of women and 12.2% of men received at least one prescription, and 64.8 DDDs (WHO-def.) per 1000 insured people/day were prescribed. Overall, omeprazole use decreased over the observation period and was steadily replaced by pantoprazole, especially when co-prescibed with clopidogrel. An on-label PPI-indication was not reported at first intake in 52.0% of new users.

Conclusions: The utilization of prescribed PPIs has decreased since 2016. However, a large proportion of new PPI-users had no documentation of a potential indication, and the sums of DDDs prescribed often seemed not to comply with guidelines.

Keywords: Acid-related diseases; Drug use; Indications; Proton pump inhibitors.

Fig. 1

Dispensed DDDs (German definition) of proton pump inhibitors per calendar year during the study period, stratified by active agent (dexlansoprazole and rabeprazole not shown due to small numbers, all age groups)

Fig. 2

(a) Prevalence of PPI-use (at least one prescription) per 100 insured people, 2010–2018, age-standardized to 2010. (b) Age-and sex-specific prevalence of PPI-use (at least one prescription) per 100 insured people in 2018 (unstandardized)

Fig. 3

DDDs (WHO) per 1000 insured people per day, 2010–2018

Fig. 4

Proportions of co-prescriptions of clopidogrel and different PPIs/H2RA in people who used clopidogrel, quarterly assessment, 2010/quarter 2 to 2018/quarter 3