Authors: (including presenting author): :
Tong JCF (1), Young G (1), Liu A (2), Wong H (3), Leung WYS (4), Mak K (5), Ng V (6), Lim WL (7), Ng A (8), Chui WCM (1)
Affiliation: :
(1) Chief Pharmacist’s office, HAHO (2) Department of Pharmacy, PYNEH (3) Department of Pharmacy, QMH (4) Department of Pharmacy, QEH (5) Department of Pharmacy, UCH (6) Department of Pharmacy, PMH (7) Department of Pharmacy, PWH (8) Department of Pharmacy, TMH
Keyword 1: :
Proton Pump Inhibitors
Keyword 2: :
Drug Utilization Review
Keyword 3: :
Cost-Effective Prescribing
Keyword 4: :
Formulary Optimization
Keyword 5: :
Pharmacist Interventions
Keyword 6: :
Financial Savings
Introduction: :
Proton pump inhibitors (PPIs) constitute a major and rapidly increasing component of the Hospital Authority (HA) drug expenditure in Hong Kong. Between financial years 2022/23 and 2023/24, total PPI spending rose by 11%, from HK$90 million to HK$99 million. To address this unsustainable growth, the Chief Pharmacist’s Office (CPO) initiated a comprehensive, HA-wide drug utilisation review (DUR) in collaboration with Cluster Drug and Therapeutics Committees and pharmacy departments across all seven hospital clusters.
Objectives: :
To promote clinically appropriate and cost-effective PPI prescribing in HA through systematic DUR and evidence-based formulary optimisation.
Methodology: :
A structured review of the efficacy, safety, and cost-effectiveness of PPIs was conducted. Notable cost inefficiencies were identified; for instance, lansoprazole, which accounted for only 7.5% of oral PPI consumption, represented 44.6% of total expenditure owing to its substantially higher unit cost. The cost-effectiveness of each PPI was evaluated, and esomeprazole was determined to be a suitable alternative to lansoprazole, as it can be administered via nasogastric tube in patients with swallowing difficulties. In collaboration with COC(Nursing), the feasibility and safety of crushing esomeprazole tablets for nasogastric administration were assessed. Based on the available evidence, a unified prescribing guideline was developed and endorsed, designating pantoprazole as the preferred PPI for patients not requiring nasogastric administration, with esomeprazole for patients necessitating administration via nasogastric tubes ≥12 French in size. The recommendations were endorsed by key stakeholders and followed by the dissemination of educational bulletins, quarterly monitoring in the Drug Management Committee, and reports sent to the Cluster DTC chairperson to provide feedback on changes in expenditure.
Result & Outcome: :
The implementation of the optimized prescribing strategy resulted in actual saving of HK$15.6 million from January to December 2025 compared with the same period in the previous year. This was primarily achieved through a 34% reduction in the use of lansoprazole, as prescribing shifted towards esomeprazole and pantoprazole, the consumption of which increased by 48.6% and 2.2%, respectively. As a result of this change, the overall expenditure on PPIs decreased significantly by 18% during the period. This initiative also appears to have enhanced rational PPI use by increasing clinician awareness, facilitating more frequent deprescribing of unnecessary long-term PPI therapy. This CPO coordinated DUR with collaboration with pharmacy departments and doctors from 7 clusters successfully embedded evidence-based, cost-effective PPI prescribing across HA, with an emphasis on reducing inappropriate use and unnecessary long-term PPI therapy. The substantial financial savings achieved validate the value of structured medication governance and have released resources for enhancing patient care. The initiative demonstrates the impact of pharmacist-driven interventions in optimising high-expenditure drug classes and will serve as a model for future DURs targeting other therapeutic categories, particularly where generic or biosimilar alternatives exist. Reviews focusing on direct oral anticoagulants and inhaler use in chronic obstructive pulmonary disease (COPD) have already commenced, with additional DURs planned in the coming months. Such strategic, system-wide initiatives are essential to promote rational medicine use and ensure the long-term sustainability of public healthcare services in Hong Kong.
