Romano Sónia, Rodrigues António Teixeira, Torre Carla, Perelman Julian
Centre for Health Evaluation & Research/Infosaúde, National Association of Pharmacies (CEFAR-IF/ANF), Lisbon, Portugal.
NOVA National School of Public Health, NOVA University Lisbon, Lisbon, Portugal.
BMC Health Serv Res. 2025 Jan 6;25(1):30. doi: 10.1186/s12913-024-12033-5.
Proton-pump-inhibitors (PPIs) are overprescribed, posing challenges to patients and healthcare systems. In Portugal, the public National Health Service (NHS) provides universal coverage and reimburses medication regardless of prescription origin, i.e., public or private. This study aimed to compare PPIs outpatient prescription patterns and costs among older adults in the private and public sectors.
A nationwide retrospective ecological study was conducted on PPIs prescribed for older adults in Portugal from 2020-2022. Data on defined daily doses (DDDs) and prices were obtained from a national public database by healthcare sector, sex, and age group (65-74, ≥ 75 years). The market share of DDD per 1000 older adults per day and the mean price per DDD (€/DDD) for all PPIs substances were compared between the public and private sectors.
PPIs-DDDs accounted for 5.3% of all outpatient DDDs prescribed in the private sector and 5.9% in the public sector. The private sector prescribed PPIs at a 20% higher price (0.126 €/DDD) than the public (0.106 €/DDD), with greater differences among the most expensive substances (rabeprazole, lansoprazole and esomeprazole). Omeprazole (cheapest) was mostly prescribed in the public sector. In the private sector, a similar pattern was observed among those aged ≥ 75 years, whereas esomeprazole was most prescribed for those aged 65-74 years.
Given the widespread prescription of PPIs and the associated cost, it is crucial to reinforce incentives to promote rational PPIs prescription and encourage deprescription when necessary, in both sectors. Since the NHS also reimburses medications prescribed in private units, implementing monitoring measures and financial incentives to promote responsible prescribing in this sector should also be considered.
质子泵抑制剂（PPIs）存在过度处方的情况，给患者和医疗系统带来了挑战。在葡萄牙，国家公共卫生服务体系（NHS）提供全民覆盖，并对药品进行报销，无论处方来源是公立还是私立。本研究旨在比较私立和公立部门中老年人使用PPIs的门诊处方模式和费用。
对2020年至2022年葡萄牙为老年人开具的PPIs进行了一项全国性回顾性生态研究。从国家公共数据库中获取按医疗部门、性别和年龄组（65 - 74岁、≥75岁）划分的限定日剂量（DDDs）和价格数据。比较了公立和私立部门中所有PPIs药物每1000名老年人每天的DDD市场份额以及每DDD的平均价格（€/DDD）。
PPIs - DDDs在私立部门所有门诊DDDs中占5.3%，在公立部门占5.9%。私立部门开具PPIs的价格（0.126 €/DDD）比公立部门高20%（0.106 €/DDD），在最昂贵的药物（雷贝拉唑、兰索拉唑和埃索美拉唑）中差异更大。奥美拉唑（最便宜）大多在公立部门开具。在私立部门，≥75岁人群中观察到类似模式，而埃索美拉唑在65 - 74岁人群中开具最多。
鉴于PPIs的广泛处方及相关成本，在两个部门加强激励措施以促进PPIs合理处方并在必要时鼓励减药至关重要。由于NHS也会报销私立机构开具的药物，因此也应考虑在该部门实施监测措施和经济激励措施以促进负责任的处方行为。
