Metaxas Evdokia S, Bain Kevin T
Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
J Pharm Technol. 2015 Aug;31(4):167-176. doi: 10.1177/8755122515575177. Epub 2015 Mar 9.
A growing body of evidence provides proof that proton pump inhibitors (PPIs) are overused in the general population and that such use is associated with adverse risks and unnecessary costs. Our objective was to systematically evaluate PPI overuse in the veteran population. A literature search using MEDLINE and CINHAL databases (1946-December 2014) was performed using the search term coupled with each of the following key words: , and . Searches were limited to studies and reviews in English language and human subjects. Additional references were identified from a review of literature citations. All articles that centrally addressed the issue of PPI overuse were evaluated, following the PRISMA guidelines for systematic reviews. Data were extracted into Microsoft Excel 2013. Articles that focused on the pediatric or non-US veteran populations were excluded. Among 30 articles included, 5 evaluated PPI overuse in veterans. The reported prevalence rate of PPI overuse in veterans ranged from 33% to 67%. Several cases reported PPI-associated -associated diarrhea and pneumonia. One Veterans Affairs center reported the total cost of PPI overuse to be more than $200 000 based on over-the-counter costs and more than $1.5 million based on average wholesale price cost. PPI overuse is common among veterans and exposes them to adverse risks and costs the system enormous dollars. Based on the findings of this review, we provide recommendations to curb PPI overuse among veterans and in the Veterans Affairs system.
越来越多的证据证明，质子泵抑制剂（PPI）在普通人群中存在过度使用的情况，而且这种使用与不良风险和不必要的成本相关。我们的目标是系统评估退伍军人中PPI的过度使用情况。使用MEDLINE和CINHAL数据库（1946年至2014年12月）进行文献检索，检索词与以下每个关键词组合使用： ，以及 。检索限于英文研究和综述以及人类受试者。通过对文献引用的回顾确定了其他参考文献。按照系统评价的PRISMA指南，对所有集中讨论PPI过度使用问题的文章进行了评估。数据被提取到Microsoft Excel 2013中。排除了关注儿科或非美国退伍军人人群的文章。在纳入的30篇文章中，有5篇评估了退伍军人中PPI的过度使用情况。报告的退伍军人中PPI过度使用的患病率在33%至67%之间。几例报告了与PPI相关的腹泻和肺炎。一个退伍军人事务中心报告，基于非处方成本，PPI过度使用的总成本超过20万美元，基于平均批发价格成本则超过150万美元。PPI的过度使用在退伍军人中很常见，使他们面临不良风险，并给系统带来巨大成本。基于本综述的结果，我们提出了遏制退伍军人及退伍军人事务系统中PPI过度使用的建议。
