COMPLIANCE WITH RESTRICTIONS ON THE SUBSIDIZED USE OF PROTON PUMP INHIBITORS IN AUSTRALIA

Aims To determine among a cohort of patients newly dispensed a prescri ption for a proton pump inhibitor (PPI) the extent of prior use of oth er less expensive agents such as antacids and Hz-receptor antagonists as evidence of a 'stepped care' approach to peptic ulcer and oesophage al disease. Methods A retrospective drug utilization study was conduct ed within the Pharmaceutical Benefits Scheme (PBS) claims database in Australia. A cohort of social security recipients, who received approv al for PPI supply in the month of October 1996, had no prior PPI appro val in the previous 18 months and went on to have the drug dispensed, was assembled. This group of 'new PPI starters' was then examined for supply of less expensive prescription medicines to treat peptic ulcer and oesophageal disease in the 12 months prior to obtaining their PPI approval. Results In a cohort of 4554 defined new PPI users, 1205 (26. 5%) showed no use of H-2-receptor antagonists, antacids, cisapride, cy toprotectants or antiregurgitants in the 12 month period prior to comm encing the PPI. The major reason for use given by prescribers for PBS supply was 'severe refractory ulcerating oesophagitis' . Conclusions S ubsidized supply is sun-entry restricted on cost-effectiveness grounds to refractory peptic ulcer disease or severe oesophageal disease. Des pite this, utilization and epidemiological data suggest that there is widespread leakage of use outside these indications particularly to le ss severe forms of oesophageal disease. This patient tracking study ha s shown within the PBS database that around a quarter of the patients are treated directly with a PPI without being prescribed less expensiv e agents at least in the preceding 12 months.