Peptic ulcer disease drugs usage patterns and its economic burden in a tertiary health institution in Niger Delta, Nigeria

Abstract

Background: Drug utilization evaluation for peptic ulcer disease and its cost  implication are rare in Niger Delta. The objective of the study was to evaluate drug usage pattern in peptic ulcer diseases as well as its cost implications.
Methods: The cross sectional drug use evaluation study involving the use of  questionnaire and patient case notes was carried out in a tertiary health institution. The validated pretested questionnaire was interviewer administered to 300 patients sampled consecutively followed by a retrospective review of their respective case notes between April to November 2013. Information collected include risk factors, prescribed drugs, Helicobacter pylori assay test results among others. Cost of each drug and therapy were then computed appropriately. Data was analyzed using  Statistical package for Social Sciences (SPSS) version 20, Microsoft Excel and Graph Pad Prism for windows Instat Version 3.
Results: Out of the 300 patients, H. pylori test was conducted in 262 (87.3%) while the presence or absence of the organisms could not be confirmed in the remaining  38 subjects. Out of the 262 patients with H. pylori test results, only 166  representing 63.4% were positive. History of non-steroidal anti-inflammatory drugs (NSAID) usage was very high among the subjects (250; 83.3%) and highest for ibuprofen 146 (48.7%). The most prescribed drugs were antacids (268; 89.3%), amoxicillin (165; 55.0%), and a combined formulation of omeprazole, tinidazole, and clarithromycin in 140 (46.7%) subjects, followed by omeprazole alone (125; 41.7%).The national direct cost implication for the estimated 17.6 million is in the range of NGN186,849,000,000.00 ($958,200,000.00), out which  NGN109,867,000,000.00 ($563,420,513.00) was for PUD drugs (50.9%) and NGN32,698,575,000.00 ($167,685,000.00) for H. pylori tests (17.5%), while the remaining 31.7% valued at NGN59,231,133,000.00 ($303,749,400.00) was for non-ulcer drugs, personnel and transportation.
Conclusion: The pattern of drugs usage is consistent with standard treatment  guidelines. Peptic ulcer drugs for the 300 subjects constituted NGN1,618,641  ($8300.72) which represents 73.0% of the total amount spent on drugs. The  national direct cost of PUD is close to NGN200 billion ($1.04 billion). Updated  information on drug usage and their costs is needed for improved usage and system efficiency.

Keywords: Peptic ulcer, H. pylori, Cost of illness, Pharmacoeconomics