Increased health costs from mandated Therapeutic Substitution of proton pump inhibitors in British Columbia

Increased health costs from mandated Therapeutic Substitution of proton pump inhibitors in British Columbia.

BACKGROUND In 2003, British Columbia's PharmaCare programme implemented a drug reimbursement policy called Therapeutic Substitution, which required patients with acid-related diseases, primarily gastro-oesophageal reflux disease (GERD), to make a medically unnecessary switch from their prescribed proton pump inhibitor (PPI) to the cheapest available brand name PPI (Pariet, rabeprazole sodium), ...

Genetic polymorphism of CYP2C19 & therapeutic response to proton pump inhibitors.

Proton pump inhibitors (PPIs) are extensively metabolized in the liver by CYP2C19, that demonstrates genetic polymorphism with 21 mutant alleles. The subjects can be divided into 2 groups with respect to CYP2C19 phenotypes viz., extensive metabolizers (EMs) and poor metabolizers (PMs) of PPIs. This division results in marked interindividual variations in the pharmacokinetics and pharmacodynamic...

Formulary Substitution of Proton Pump Inhibitors Based on Acquisition Price: Changes in Usage and Costs of Acid-Suppressant Therapies

0.72-fold in the ICU after the switch (95% CI, 0.52–1.00, P = .04). Conclusion. Substituting a less expensive PPI did not alter usage outside the ICU, but it was associated with increased usage in the ICU. Conversely, the use of IV H2RAs decreased in the ICU. Despite substantially more PPI use after the formulary switch, the cost of acid-suppressant therapy was unchanged overall; it was lower i...

Proton Pump Inhibitors: Omeprazole

Oral Proton Pump Inhibitors

There is currently a lack of evidence to suggest superior clinical efficacy of one oral proton pump inhibitor over any other. Proton pump inhibitors display similar doseresponse relationships with similar potencies and efficacies at the equivalent dose. The decision to select one proton pump inhibitor over another is likely to be based on the agents’ licensed indication, patient tolerability an...