The economic impact of overprescribing PPIs should not
be disregarded. Between 25% and 70% of patients who take
these drugs long term do not have an appropriate indication.55
A retrospective review of 946 patients conducted in an
ambulatory care setting found only 35% of the patients were
given PPIs for an appropriately documented upper gastrointestinal
tract diagnosis, whereas the remaining patients were
given PPIs for either extraesophageal symptoms, unclear gastroprotection,
or no documented appropriate indication.56 The
total yearly cost excess was estimated at $233,994 based on
over-the-counter PPIs, and $1,566,252 based on average
wholesale price costs.57Coupled with the fact that on-demand
therapy for moderate to severe NERD has been shown to be a
cost-effective approach,57 overprescribing PPIs has a significant
impact on healthcare expenditures