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A Retrospective Cross-Sectional Study With Cost and Predictive Analysis of Inappropriate Proton Pump Inhibitor
Ramsha Abid1, Qasim Khan2, Muhammad Junaid Hassan Sharif2
1Shaukat Khanum Memorial Cancer Hospital and Research Centre, Peshawar, Pakistan.
Background:
PPIs are among the most commonly prescribed drugs worldwide. In cancer treatment settings, they are often used preventively and to manage gut complications. Nonetheless, the issue of inappropriate prescribing continues to persist.
Objectives:
The aims and objectives of the study were to assess the appropriateness of the prescribing of PPIs in cancer patients as recommended by AGA and determine the predictors and financial burden of irrational use and adherence to deprescribing.
Methods:
A research study was conducted at cancer hospital, Peshawar, Pakistan as a retrospective cross-sectional study. A total of 200 adult patients suffering from cancer were subjected to evaluation between February and August 2023 who were taking PPIs. According to the AGA Best Practice Advice, prescriptions were assessed for indication, dose, frequency, and duration. The analysis also included deprescribing practices. The study employed chi-square and multi-variate logistic regression.
Results:
Over a quarter (27%) of the prescriptions were justified for indications supported by guidelines and overall rational prescribing was seen in only 1 in 8 (12.5%) cases. Documentation of indications was available in 50.5% and was the strongest predictor of rational use (OR 6.23; 95% CI 2.06-18.91; P = .001). Proper prescription practices were also associated with increasing age (OR 1.048, P = .01) and inpatient status (OR 3.87, P = .009). Irrational prescriptions were associated with significantly greater capsule counts and cost (PKR 564.00 vs PKR 292.60, P = .001). Minimal adherence was seen with no case meeting the key criteria of discontinuation therapy or dose reduction.
Conclusion:
Oncology patients frequently receive inappropriate PPI prescribing, that is, not aligned with guideline-recommended deprescribing practices. To ensure more rational medication use, enhanced indication documentation, regular medication reviews, and structured deprescribing strategies are essential to reduce costs and minimize risk for patients.
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