Deprescribing of proton pump inhibitors in older patients: A cost-effectiveness analysis

• Published in: PloS one Vol. 19; no. 10; p. e0311658
• Main Authors: Xie, Mingxi, You, Joyce H. S.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 07.10.2024
• Subjects: Aged; Aged patients; Aged, 80 and over; Ambulatory care; Biology and Life Sciences; Cardiac arrhythmia; Cohort analysis; Cost analysis; Cost benefit analysis; Cost effectiveness; Cost-Effectiveness Analysis; Deprescriptions; Disease; Dosage and administration; Drug dosages; Drug therapy; Emergency medical services; Female; Gastroesophageal reflux; Health care; Histamine; Hong Kong; Hospitalization; Hospitals; Humans; Infections; Inhibitors; Life expectancy; Male; Medical Subject Headings-MeSH; Medicine and Health Sciences; Meta-analysis; Monte Carlo simulation; Mortality; Observational studies; Older people; Patients; People and places; Physical sciences; Pneumonia; Proton pump inhibitors; Proton Pump Inhibitors - economics; Proton Pump Inhibitors - therapeutic use; Protons; Quality-Adjusted Life Years; Research and Analysis Methods; Sensitivity analysis; Social Sciences; Statistical analysis; Hong Kong; China; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0311658

Over-prescribing of proton-pump inhibitors (PPIs) is widely observed in older patients. Clinical findings have showed that deprescribing service significantly decreased inappropriate PPIs utilization. We aimed to examine the cost-effectiveness of PPI deprescribing service from the perspective of Hong Kong public healthcare provider. A decision-analytic model was constructed to examine the clinical and economic outcomes of PPI deprescribing service (deprescribing group) and usual care (UC group) in a hypothetical cohort of older PPI-users aged ≥65 years in the ambulatory care setting. The model inputs were retrieved from literature and public data. The model time-frame was one-year. Base-case analysis and sensitivity analysis were performed. Primary model outcomes were direct medical cost and quality-adjusted life-years (QALYs) loss. In base-case analysis, the deprescribing service (versus UC) reduced total direct medical cost by USD235 and saved 0.0249 QALY per PPI user evaluated. The base-case results were robust to variation of all model inputs in one-way sensitivity analysis. In probabilistic sensitivity analysis, the deprescribing group was accepted as cost-effective (versus the UC group) in 100% of the 10,000 Monte Carlo simulations. In conclusion, the PPI deprescribing service saved QALYs and reduced total direct medical cost in older PPIs users, and showed a high probability to be accepted as the cost-effective option from the perspective of public healthcare provider in Hong Kong.