Ongoing activities to influence the prescribing of proton pump inhibitors within the Scottish National Health Service: their effect and implications

Introduction: There has been a considerable increase in the use of proton pump inhibitors (PPIs) in recent years due to their effectiveness versus H2 antagonists. This includes reducing GI bleeds in patients at risk. However, there are concerns with their long term use and potential costs. Costs can be reduced with increased prescribing of low cost generic PPIs. Aims: To analyse the influence of multiple demand-side measures in Scotland in recent years to increase the prescribing of low cost generic PPIs as well as encourage the prescribing of lower strength PPIs. Methods: Documenting utilization (mainly items dispensed) and expenditure in Scotland from 2001 to 2017 using health authority databases combined with documenting the multiple initiatives and measures both nationally and regionally. Results: The multiple measures in Scotland ensured high International non-proprietary name prescribing (up to 100% for some PPIs) as well as the prescribing of generic versus patented PPIs, with costs of generic PPIs as low as 8.5% of their pre-patent loss prices. Overall, total expenditure on PPIs in Scotland was 66.7% lower in 2017 at GB£18.83million compared to 2001 levels. This was despite a 3.06-fold increase in PPI utilization during this period. The savings were driven by the increasing use of generic omeprazole and lansoprazole versus patent protected PPIs. There was also a reduction in the prescribing of high strength PPIs during this period. Conclusion: Multiple initiatives in Scotland in recent years have reduced expenditure on PPIs despite appreciably increased utilisation. Multiple initiatives have also helped to reduce the prescribing of higher strength PPIs. This is an exemplar to other countries seeking to enhance their prescribing efficiency