Long-term use of proton-pump inhibitors: whole-of-population patterns in Australia 2013-2016

Benjamin Daniels; Sallie-Anne Pearson; Nicholas A Buckley; Claudia Bruno; Helga Zoega

doi:10.1177/1756284820913743

Long-term use of proton-pump inhibitors: whole-of-population patterns in Australia 2013-2016

Therap Adv Gastroenterol. 2020 Mar 19:13:1756284820913743. doi: 10.1177/1756284820913743. eCollection 2020.

Authors

Benjamin Daniels¹, Sallie-Anne Pearson², Nicholas A Buckley³, Claudia Bruno², Helga Zoega²

Affiliations

¹ Medicines Policy Research Unit, Centre for Big Data Research in Health, UNSW Sydney, AGSM Building, Level 2, Kensington, NSW 2052, Australia.
² Medicines Policy Research Unit, Centre for Big Data Research in Health, UNSW, Sydney, NSW, Australia.
³ Clinical Pharmacology and Toxicology Research Group, Discipline of Pharmacology, University of Sydney, Sydney, NSW, Australia.

Abstract

Background: Proton-pump inhibitors (PPIs) are among the most prescribed medicines worldwide and concern about their long-term use is growing. We used dispensing claims for every person in Australia dispensed publicly subsidized PPIs between 2013 and 2016 to determine the incidence and prevalence of PPI use and to examine the patterns and durations of PPI treatment among individuals continuing treatment beyond the guideline-recommended maximum 12 weeks.

Methods: We estimated annual prevalence and incidence per 100 people and duration of treatment for every Australian dispensed publicly subsidized PPIs between 2013 and 2016. We examined patterns of PPI treatment in three patient subgroups using PPIs for more than 12 weeks duration; people receiving maintenance, long-term continuous or long-term intermittent treatment. We calculated the proportion in each subgroup stepping down from higher to lower PPI strengths, stepping up from lower to higher PPI strength and discontinuing treatment.

Results: PPIs were dispensed to 4,388,586 people; 60% were women; median age at initiation was 52 years [interquartile range (IQR): 36-65]. Standard and high strength PPIs accounted for 95% of dispensings. Annual incidence and prevalence were 3.9/100 and 12.5/100, respectively, in 2016 and highest among individuals over 65 years (prevalence range: 33-43/100). Most people (67%) stopped treatment after one dispensing; while 25%, 6% and 10% continued on maintenance, long-term continuous and long-term intermittent treatment, respectively. Median duration of treatment in people continuing treatment was 501 days (IQR: 180-not reached) for maintenance treated individuals and 'not reached' for long-term treated individuals. We observed 35%, 20% and 47% of people stepping down from higher to lower treatment strengths on maintenance, long-term continuous and long-term intermittent treatment, respectively.

Conclusions: Longer-term treatment with higher strength PPIs is common. Targeted regulation of PPI prescribing may improve the uptake of lower strength formulations and reduce both harms and costs associated with long-term PPI treatment.

Keywords: long-term; population-based; proton-pump inhibitor.