Mody Reema, Eisenberg Debra, Hou Likun, Kamat Siddhesh, Singer Joseph, Gerson Lauren B
Takeda Pharmaceuticals International Inc, Deerfield, IL.
Clinicoecon Outcomes Res. 2013 Apr 22;5:161-9. doi: 10.2147/CEOR.S41189. Print 2013.
The purpose of this study was to assess differences in health care resource utilization and costs associated with once-daily and twice-daily proton pump inhibitor (PPI) therapy. Most patients with gastroesophageal reflux disease (GERD) achieve symptom control on once-daily PPI therapy, but approximately 20%-30% require twice-daily dosing.
Patients were ≥18 years of age with at least one medical claim for GERD and at least two PPI claims from HealthCore's Integrated Research Database (HIRD(SM)) during 2004-2009. Patients were continuously eligible for 12 months before and after the index date (date of first PPI claim). Based on PPI dosing throughout the post-index period (quantity of medication dispensed/number of days supply), patients were classified as once-daily (dose ≤ 1.5 pills per day) or twice-daily (≥1.5) PPI users.
The study cohort included 248,386 patients with GERD (mean age 52.8 ± 13.93 years, 56% females) of whom 90% were once-daily and 10% were twice-daily PPI users. The Deyo-Charlson Comorbidity Index for once-daily and twice-daily PPI users was 0.70 ± 1.37 and 0.89 ± 1.54, respectively (P < 0.05). More once-daily patients had claims for Barrett's esophagus (5% versus 2%, P < 0.0001) than twice-daily patients. Post-index, higher proportions of twice-daily patients had at least one GERD-related inpatient visit (7% versus 5%), outpatient visit (60% versus 49%), and office visit (48% versus 38%) versus once-daily patients (P < 0.0001). Mean total GERD-related health care costs were $2065 ± $6636 versus $3749 ± $11,081 for once-daily and twice-daily PPI users, respectively (P < 0.0001).
Patients receiving twice-daily PPI therapy were likely to have more comorbid conditions and greater health care utilization and overall costs compared with patients using once-daily PPI therapy.
本研究旨在评估每日一次和每日两次质子泵抑制剂（PPI）治疗在医疗资源利用和成本方面的差异。大多数胃食管反流病（GERD）患者采用每日一次PPI治疗即可控制症状，但约20%-30%的患者需要每日两次给药。
研究对象为年龄≥18岁，在2004年至2009年期间至少有一项GERD医疗索赔记录且至少有两项PPI索赔记录的患者，这些记录来自HealthCore综合研究数据库（HIRD(SM)）。患者在索引日期（首次PPI索赔日期）前后连续12个月符合条件。根据索引期后整个时间段内的PPI给药情况（配药量/供应天数），将患者分为每日一次（每日剂量≤1.5片）或每日两次（≥1.5片）PPI使用者。
研究队列包括248,386例GERD患者（平均年龄52.8±13.93岁，56%为女性），其中90%为每日一次PPI使用者，10%为每日两次PPI使用者。每日一次和每日两次PPI使用者的Deyo-Charlson合并症指数分别为0.70±1.37和0.89±1.54（P<0.05）。与每日两次给药的患者相比，每日一次给药的患者中患有巴雷特食管的比例更高（5%对2%，P<0.0001）。索引期后，与每日一次给药的患者相比，每日两次给药的患者中有更高比例的患者至少有一次与GERD相关的住院就诊（7%对5%）、门诊就诊（60%对49%）和办公室就诊（48%对38%）（P<0.0001）。每日一次和每日两次PPI使用者与GERD相关的平均医疗总费用分别为2065±6636美元和3749±11,081美元（P<0.0001）。
与每日一次PPI治疗的患者相比，接受每日两次PPI治疗的患者可能合并更多疾病，医疗资源利用更多，总体成本更高。
