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Deprescribing of proton pump inhibitors in older patients: A cost-effectiveness analysis

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  • Mingxi Xie
  • Joyce H S You

Abstract

Over-prescribing of proton-pump inhibitors (PPIs) is widely observed in older patients. Clinical findings have showed that deprescribing service significantly decreased inappropriate PPIs utilization. We aimed to examine the cost-effectiveness of PPI deprescribing service from the perspective of Hong Kong public healthcare provider. A decision-analytic model was constructed to examine the clinical and economic outcomes of PPI deprescribing service (deprescribing group) and usual care (UC group) in a hypothetical cohort of older PPI-users aged ≥65 years in the ambulatory care setting. The model inputs were retrieved from literature and public data. The model time-frame was one-year. Base-case analysis and sensitivity analysis were performed. Primary model outcomes were direct medical cost and quality-adjusted life-years (QALYs) loss. In base-case analysis, the deprescribing service (versus UC) reduced total direct medical cost by USD235 and saved 0.0249 QALY per PPI user evaluated. The base-case results were robust to variation of all model inputs in one-way sensitivity analysis. In probabilistic sensitivity analysis, the deprescribing group was accepted as cost-effective (versus the UC group) in 100% of the 10,000 Monte Carlo simulations. In conclusion, the PPI deprescribing service saved QALYs and reduced total direct medical cost in older PPIs users, and showed a high probability to be accepted as the cost-effective option from the perspective of public healthcare provider in Hong Kong.

Suggested Citation

  • Mingxi Xie & Joyce H S You, 2024. "Deprescribing of proton pump inhibitors in older patients: A cost-effectiveness analysis," PLOS ONE, Public Library of Science, vol. 19(10), pages 1-13, October.
    • Handle: RePEc:plo:pone00:0311658
    DOI: 10.1371/journal.pone.0311658
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    References listed on IDEAS

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    1. Allison A Lambert & Jennifer O Lam & Julie J Paik & Cesar Ugarte-Gil & M Bradley Drummond & Trevor A Crowell, 2015. "Risk of Community-Acquired Pneumonia with Outpatient Proton-Pump Inhibitor Therapy: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 10(6), pages 1-18, June.
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