Authors: (including presenting author): :
MIU HS, LAM WL, CHUNG KYE
Affiliation: :
Department of Pharmacy Hong Kong Buddhist Hospital
Keyword 2: :
Drug Utilization Evaluation
Keyword 3: :
Proton Pump Inhibitors
Keyword 4: :
cost effective
Introduction: :
In 2024, a Drug Utilization Evaluation (DUE) on Proton Pump Inhibitors (PPI) was conducted by the HAHO Drug Management Committee. The DUE involved an evaluation of how PPI are being prescribed and used within HA. The goal is to ensure that PPIs are being used appropriately, safely, and cost-effectively. The review concluded that Esomeprazole, Rabeprazole and Pantoprazole are more cost-effective options available in the HA drug formulary and the switch from lansoprazole to these alternatives should be promoted. Subsequently, a gentle approach including email promotion, promulgation via hospital meetings such as the Drug and Therapeutic Committee, Medication Safety Committee or Quality & Safety meetings and department meetings was adopted in Hong Kong Buddhist Hospital (HKBH) in Dec 2024.
Objectives: :
To encourage cost effective use of PPI in Hong Kong Buddhist Hospital through an interventional approach
Methodology: :
In order to facilitate the comparison and to analyze the consumption/expenditure of PPI before and after the promotion, a template was designed by HKBH Pharmacy. Analysis and graphical presentation of the usage and expenditure were generated for comparison. Following the gentle approach adopted in December 2024 to promote cost-effective PPI use at HKBH, significant outcomes were observed. Analysis of dispensing data from the PIER system, facilitated by the HKBH Pharmacy’s template, revealed a notable 14.0% reduction in PPI expenditure in the first quarter of 2025 compared to the fourth quarter of 2024. Additionally, Lansoprazole consumption decreased by 22.7% over the same period, reflecting a successful switch to more cost-effective alternatives, such as Esomeprazole, Rabeprazole, and Pantoprazole, as recommended by the HAHO Drug Management Committee. To further enhance the cost-effective use of PPI in HKBH, an interventional approach was implemented following the 2024 DUE. A targeted Lansoprazole Timeout Program was introduced, comprising inpatient and outpatient interventions. For inpatients, from June to July 2025, a patient list of those prescribed Lansoprazole was generated twice weekly (Mondays and Fridays) using the Pharmacy Data Query Template for a four-week trial. This list was distributed to wards, where ward staff placed reminder cards in patient profiles, prompting doctors to review Lansoprazole prescriptions and consider switching to more cost-effective PPI, such as Pantoprazole or Esomeprazole, or stepping down to H2 blockers or discontinuation. This inpatient intervention had a significant impact not only at HKBH but also at other cluster acute hospitals, such as Queen Elizabeth Hospital (QEH) and Kwong Wah Hospital (KWH) because successful switches to cost-effective PPI would be carried over to outpatient follow-ups at QEH and KWH upon patient discharge. For outpatients, a one-off intervention was conducted in June 2025, which utilized the Clinical Management System (CMS) reminder function, generating a patient list covering all outpatients on Lansoprazole before this time point. A prompt was set to pop up when doctors access these patients’ profiles in CMS.
Result & Outcome: :
Notably, these interventions, implemented for less than a full quarter period, have led to a highly significant reduction in Lansoprazole consumption and expenditure, with a quarter period-over-quarter period decrease of 33.8% and 33.4%, respectively, and a year-over-year reduction of 53.4% and 53.1%, respectively. For the way forward, other interventional approach includes integrating automated system prompts to alert physicians to review PPI prescriptions, or initiating prior authorization requirements for certain medications can be considered. Interventional approaches to drug utilization evaluation are a critical tool for improving the appropriateness, and cost-effectiveness of drug prescribing. When well-designed and implemented, these interventions can lead to comparable patient outcomes but measurable saving in drug expenditure.
