Lb. Gerson et al., Clinical and fiscal impact of lansoprazole intolerance in veterans with gastro-oesophageal reflux disease, ALIM PHARM, 14(4), 2000, pp. 397-406
Background: Omeprazole was replaced by lansoprazole as the only proton pump
inhibitor on the Veterans Affairs (VA) formulary in February 1997. We aime
d to assess the clinical and fiscal impact of this conversion at two VA hos
pitals.
Methods: We identified lansoprazole intolerant patients using pharmacy data
bases. We reviewed medical records to obtain data regarding reasons for lan
soprazole intolerance. The costs of the formulary change and the savings to
the VA were calculated.
Results: A total of 3833 patients required long-term proton pump inhibitor
therapy; 2224 (58%) were started on lansoprazole and 1479 (39%) were conver
ted from omeprazole to lansoprazole. The remaining 130 (3.4%) patients were
never converted from omeprazole to lansoprazole. Of the 3833 patients, 325
(8.5%) currently receive omeprazole therapy; of these, 195 out of 3703 (5.
3%) patients are true lansoprazole failures; 172 of these 195 patients comp
leted the study. Most (87%) of the lansoprazole intolerant patients receive
d prior omeprazole. Discontinuation of lansoprazole was due to poor symptom
control in 69% and/or side-effects (22%) including diarrhoea (10%), abdomi
nal pain (5%), or hives (1%). The 1-year cost of managing lansoprazole fail
ure in 195 patients was $61 690. However, the savings to the VA during the
same time period, which totalled $321 360, more than offset the costs assoc
iated with the conversion.
Conclusions: Lansoprazole intolerance requiring omeprazole conversion occur
red in 5% of veterans on proton pump inhibitor therapy for chronic gastro-o
esophageal reflux disease (GERD) symptoms and in 10% of patients with prior
omeprazole success. The VA realized substantial cost savings in associatio
n with the formulary change.