RATIONAL SELECTION OF PROTON PUMP INHIBITORS (PPIs) THROUGH AN OBJECTIVE SCORING SYSTEM FOR EFFECTIVE FORMULARY MANAGEMENT
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Date
2011-06
Authors
LIM, CHU ANN
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Abstract
Rational drug selection is fundamental for effective formulary management. The
rationale of an objective scoring system is to establish and make available drugs
which are proven to be the most efficacious, safe and cost-effective without
compromising the quality of patient care. The aims of Part 1 of the study were to
develop an objective scoring system by determining the criteria for 5 available PPIs
Le. esomeprazole, lansoprazole, omeprazole, pantoprazole and rabeprazole as well as
to assign scores according to the importance in the evaluation process for ihe
inclusion and exclusion of PPIs for the indication of GERD. Part 2 of the study was a
case study aim to review and compare the usage and expenditure of PPI drugs used
in Serdang Hospital with the most preferred PPI obtained in Part 1 of the study. This
study also aims to determine appropriate cost saving measure in the treatment of acid
related disease requiring PPIs. In the first part of the study, the higher the assigned
score, the higher importance the criterion is. Two hundred were assigned to
documentation, 300 points for efficacy, 200 points for safety and 300 points for cost.
Total points were 1000. A convenience sampling method was used to generate the
sample size of the participants in this survey. Self-administered questionnaire was
distributed to 165 specialists / lecturers and medical officers in various out-patient
clinics in 6 selected hospitals in Selangor and Kuala Lumpur. In the second part of
the study, a retrospective study was canied out to review all prescriptions containing
PPI drugs prescribed by the medical, gastroenterology, surgical, nephrology and
cardiology out-patient clinics in Serdang Hospital. The number of prescriptions,
cardiology out-patient clinics in Serdang Hospital. The number of prescriptions,
usage and expenditure ofPPI drugs were analyzed. Further analysis were undertaken
to estimate the potential savings that could be achieved by replacing esomeprazole,
lansoprazole, pantoprazole and rabeprazole with the generic brand omeprazole. Out
of 165 questionnaires distributed, only 73 questionnaires were successfully
completed and returned (response rate = 44.2%). The scoring system showed that
omeprazole was the most preferred PPI, followed by lansoprazole, pantoprazole,
esomeprazole and rabeprazole. The expenditure of all PPIs available in Serdang
Hospit?l in 2009 was RM 330,000.00. Omeprazole (70.41%) was the most
commonly used, followed by pantoprazole (l3.49%) and esomeprazole (12.78%).
Omeprazole contributed 39.14% of the total spending of all PPIs, followed by
pantoprazole (29.24%), esomeprazole (27.54%). It was found that 44.4% of the PPI
expenditure could be saved when all PPIs were substituted with the generic brand
omeprazole. The scoring system allows drug selection to be done in a more
objective, transparent and systematic way.
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Keywords
EFFECTIVE FORMULARY , MANAGEMENT