Cost analysis of a provincial drug program to guide the treatment of uppergastrointestinal disorders

Background: Concerned with the rising costs of its drug programs for senior s and social-assistance recipients, the government of Newfoundland and Labr ador requested: physicians and pharmacists at the Memorial University of Ne wfoundland, and members of the Newfoundland and Labrador Medical Associatio n and the Newfoundland Pharmaceutical Association to provide guidance to th e health care community for the use of drugs to treat upper gastrointestina l disorders. Methods: Algorithms for the management of dyspepsia and gastrointestinal re flux disease were created and distributed to all physicians and pharmacists in the province in June 1996. On July 1, 1996, the provincial government i mplemented a program to restrict payment for proton-pump inhibitors through its drug programs to situations defined by the algorithms. Restrictions we re not applied to the prescribing of cimetidine, ranitidine and prokinetic agents. The status of famotidine and nizatidine was changed from "open bene fit" to "special consideration," which requires prescribers to request auth orization of their use on a case-by-case basis. Results: Between July 1 and Dec 31, 1996, 973 of 1078 requests for a proton -pump inhibitor were approved (679 for gastroesophageal reflux, 186 for Hel icobacter pylori eradication, 55 for ulcer treatment and 53 for other reaso ns). The program resulted in a sustained reduction in drug expenditures. To tal drug expenditures, which had risen from $39.0 million in 1992/93 to $50 .8 million in 1995/96, fell after implementation of the program to $46.4 mi llion in 1996/97 because of a decrease of more than 80% in the use of proto n-pump inhibitors. Expenditures on proton-pump inhibitors, which had increa sed from $0.7 million for the 6 months ending March 1993 to $1.6 million fo r the 6 months ending March 1996, decreased to $0.3 million for the 6 month s ending March 1997. The use of H-2-antagonists, but not prokinetic agents, increased concomitantly with the decline in proton-pump inhibitor use. Com pared with the year preceding implementation of the program, annual combine d expenditures in the subsequent 3 years for H-2-antagonists, prokinetic dr ugs and proton-pump inhibitors were reduced by $1.6 million, $1.7 million a nd $1.0 million, respectively. Feedback from physicians and pharmacists was supportive for the clinical information and prescribing guidelines. Concer ns were mostly limited to process issues. Interpretation: The program, designed by health care professionals, approve d by health care associations and implemented by the province of Newfoundla nd and Labrador to guide the treatment of upper gastrointestinal disorders, has achieved a substantial reduction in drug expenditures.