Use of Proton Pump Inhibitors in Hungary: Mixed-Method Study to Reveal Scale and Characteristics

Abstract

Background: Due to their efficacy and tolerability, utilization of proton pump inhibitors (PPI) has significantly increased worldwide. Parallel to the clinical benefits, potential longterm side effects have been observed, which, along with increasing medical expenses and potential drug interactions, justifies the analysis of the trends of utilization. Objective: The aim of the present study was to show the level, pattern, and characteristics of PPI use. Methods: We assessed the nationwide use of proton pump inhibitors in ambulatory care based on aggregated utilization data from the National Health Insurance database. The annual PPI utilization was expressed as the number of packages and as number of DDDs per 1,000 inhabitants and per year. For 2018, we estimated PPI exposure as the number of packages and as the number of DDDs per user per year. The annual reimbursement costs of proton pump inhibitors were also calculated. Moreover, three patient-level surveys were carried out in non-gastroenterological inpatient hospital departments to reveal characteristics of proton pump inhibitor use, namely dose, duration, and indication. Results: The PPI utilisation increased from 5867.8 thousand to 7124.9 thousand packages and from 41.9 to 50.4 DDD per 1,000 inhabitants and per day between 2014 and 2018. Nationwide data showed that 14% of the adult population was exposed to proton pump inhibitors in 2018, while among hospitalized patients, the prevalence of proton pump inhibitor use was between 44.5% and 54.1%. Pantoprazole was the most frequently used active ingredient, both in the nationwide data and in the patient-level surveys. In the patient-level survey in majority of patients (71.5%-80.0%) proton pump inhibitors were prescribed for prophylaxis. Many inpatients (29.4%-36.9%) used 80 mg pantoprazole per day. The average number of PPI packages per user was 6.5 in 2018 in the nationwide data. The duration of PPI therapy was typically between 1 and 5 years in the patient-level surveys and nearly 20% of the inpatients had been taking proton pump inhibitors for more than 5 years.

The Impact of Proton Pump Inhibitor Therapy on Outcomes in COVID-19 Patients: A Retrospective, Multicenter Study

“…Several studies worldwide have reported a trend of overuse of PPIs [27][28][29][30][31]. A similar pattern has been observed in Saudi Arabia [32,33].…”

Trends in proton pump inhibitor use, reflux esophagitis, and various upper gastrointestinal symptoms from 2010 to 2019 in Japan

“…Using large-scale cohort data of generally healthy individuals in Japan, our study clearly showed a marked increase in PPI use in Japan, which is accompanied by a gradual decrease in H 2 RA use. The increasing and frequent use of PPIs has been reported in many countries such as the United States [31], France [32], Hungary [23], and Iceland [21]. In comparison with Western countries, the percentage of PPI users is still lower in Japan, but the monotonous increase and PPI use of more than 5% in a generally healthy population are noteworthy trends in Japan (Fig 1).…”

“…Although several studies have indicated the risk of long-term PPI use [18,19], increasing PPI usage has been reported in various regions of the world [20][21][22][23]. However, information regarding PPI use in East Asia is currently inadequate.…”

Proton Pump Inhibitors: Exploring Cardiovascular Complications and Prescription Protocol

“…A study in Hungary revealed that the average age of PPI users was 65 years old, with a minimum treatment interval of six months. One-fifth of the population had extended use for more than five years [ 14 ]. Patients usually do not self-deprescribe, and most primary care physicians tended to continue the same treatment without reevaluation for the need for PPIs [ 15 ].…”