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THE USE OF PROTON PUMP INHIBITORS AMONG ADULTS IN NORWAY – A NATIONWIDE DRUG UTILIZATION STUDY

Sveinung Molnes 1, Olav Spigset 2,1, liv sagatun 1,2, Øyvind Salvesen 2, Reidar Fossmark 2,3

Affiliations

1 St.Olavs Hospital, Trondheim, Norway

2 Norwegian University of Science and Technology, Trondheim, Norway

3 St. Olavs Hospital, Trondheim, Norway

Summary

AI Generated

A Norwegian nationwide registry study found a 2.8-fold increase in prevalent proton pump inhibitor use from 2009 to 2022, driven primarily by treatment of esophageal disease and GERD and prophylaxis against ulcers in patients on ulcerogenic medications, while the proportion of incident users undergoing upper endoscopy fell by half.

Prevalence of PPI use increased from 3.5% in 2009 to 9.9% in 2022, with incidence rising from 2.85% in 2011 to 5.42% in 2022, representing an increase from 15700 to 38700 defined daily doses per 1000 persons.
The absolute increase was driven by a 3.5-fold increase in esomeprazole and a 5-fold increase in pantoprazole use over the study period.
In 2022, esophageal disease and GERD accounted for 57.6% and 4.7% of defined daily doses in primary and secondary care respectively, with prophylaxis against gastroduodenal ulcer accounting for 4.8% and 0.95%.
The proportion of incident PPI users who underwent upper endoscopy around treatment start decreased from 25.3% in 2009 to 11.1% in 2022, with the decline most pronounced in patients without a reimbursement diagnosis (19.2% to 6.9%).
This nationwide study based on the Norwegian Prescription Database and Patient Registry is relevant for clinicians and policymakers monitoring PPI prescribing patterns and endoscopy utilization.

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Abstract

Introduction

The use of proton pump inhibitors (PPIs) has increased in many Western countries over the past decades. This may reflect the increasing prevalence of symptoms of gastroesophageal reflux disease (GERD) and prophylactic PPI use against gastroduodenal ulcers and haemorrhage induced by non-steroid anti-inflammatory drugs (NSAIDs) or acetylsalicylic acid. However, increasing PPI use against functional or uninvestigated dyspepsia and other inappropriate prescription have previously been documented and may also have contributed to the observed increase in PPI use. In this study we describe the change in incident and prevalent PPI use over time and the indication for prescription.

Aims & Methods

Nationwide data were retrieved from the Norwegian Prescription Database (NorPD) and consisted of information about dispensed prescription drugs. The study population consisted of all adults with at least one PPI prescription during the study period from 2009 to 2022. PPIs were defined by their ATC codes A02BC01 – C05 in addition to M01AE52, which is an esomeprazole and naproxen combination product. Prevalent PPI use was defined as the period covered by the defined daily doses (DDD) in each prescription. The indications for prescription were defined by ICPC or ICD-10 codes depending on whether PPI was prescribed in primary care or secondary health care. National data from the Norwegian Patient Registry (NPR) on all upper endoscopies performed during the study period were combined with NorPD data and it was assessed whether incident PPI users, defined as no PPI dispensal for two years, had undergone an upper endoscopy 180 days before or after incident PPI use.

Results

The use of PPI increased from 58.1 mill DDD in 2009 to 166.9 mill DDD in 2022, i.e. 15700 DDD/1000 and 38700 DDD/1000 persons. The absolute increase in DDDs was driven by a 3.5-fold increase in esomeprazole and a 5-fold increase in the use of pantoprazole.
The prevalence of PPI use increased from 3.5% in 2009 to 9.9% in 2022. The incidence of PPI use increased from 2.85% in 2011 to 5.42% in 2022.
In 2009 the dominant indications in primary and secondary health care, respectively, were esophageal disease and GERD (72.5% and 10.7% of DDDs), gastric ulcer (3.3% and 0.46% of DDDs), duodenal ulcer (0.86% and 0.21% of DDDs), while prescriptions with no reimbursement diagnosis constituted 10.2% of DDDs. In 2022 the dominant indications were esophageal disease and GERD (57.6% and 4.7% of DDDs), musculoskeletal disorders and pain (7.1% and 0.39% of DDDs and in combination with naproxen), prophylaxis against gastroduodenal ulcer (4.8% and 0.95% DDDs), while prescriptions with no reimbursement diagnosis constituted 5.2% of the DDDs.
There were 2.27 mill cases of incident PPI use in the study period and the proportion of PPI users that underwent upper endoscopy around treatment start decreased from 25.3% in 2009 to 11.1% in 2022. In patients with esophageal disease or GERD combined the proportion examined by upper endoscopy fell from 41.4% to 27.1%, while in patients without a reimbursement diagnosis the proportion fell from 19.2% to 6.9%.

Conclusion

In this nationwide study a 2.8-fold increase in prevalent PPI use was observed during the 14-year study period. This was caused by an absolute increase in PPI use against esophageal disease and GERD as well as prophylaxis in patients given ulcerogenic comedication. The proportion of incident PPI use investigated by upper endoscopy was halved.

Conference

UEG Week Vienna 2024

Topics

Oesophagus

Submission format

Abstract

Session

OESOPHAGEAL, GASTRIC AND DUODENAL (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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