Background: Several meta-analyses have supported the efficacy of proton pump inhibitors (PPIs) both in the treatment of peptic ulcers and in the prevention of ulceration, perforation, and hemorrhage from the upper gastrointestinal tract. PPIs have been associated with reducing the risk for recurrent ulcer bleeding and ulcer-related surgery, but they have not been associated with reduced mortality rate. Objectives: The aim of the current analysis was to conduct a national ecological study exploring the relationship between the consumption of PPIs and hospital discharge rates for gastrointestinal events. We also analyzed the potential savings for the Italian National Health Service (INHS) obtained by a reduction in hospitalizations for gastrointestinal events. Methods: Data provided by the Italian Ministry of Health allowed us to calculate the annual number of hospital discharge rates from 2000 to 2003 for gastrointestinal events and the national expenditure and consumption rates (expressed as defined daily doses [DDDs] per 1000 population per day) for histamine-2-receptor antagonists, prostaglandins, PPIs, and for other drugs prescribed for peptic ulcer and gastroesophageal reflux disease. Results: The results of this study suggest that there was a statistically significant relationship between the rate of hospital discharge for gastrointestinal events and PPI consumption (r = -0.99; P = 0.003). An estimated mean increase of 180.8% in the number of DDDs for PRIs was found among all Italian regions. This drug's consumption increase was associated with an increase of 61.1% in the drug expenditure for treatment of peptic ulcer and gastroesophageal reflux diseases. At the same time, there was a 23.3% reduction in hospital discharge rates for gastrointestinal events and a reduction of 24.5% in the expenditure sustained by INHS for reimbursement of diagnosis-related group tariffs. In Italy there was an absolute increase of C353 million in the expenditure for gastroprotective drugs and a reduction of euro39.6 million in the expenditure for reimbursements due to hospitallzation for gastrointestinal events. Conclusions: Based on the results of this study in the Italian population, an increase of PPI consumption was observed to coincide with a reduction of hospital admissions for gastrointestinal events. Although this was not a cost-effectiveness analysis, and some relevant societal costs were not considered, this study found that for each euro1000 spent for gastroprotective drugs a reduction of euro112 was observed in the expenditure for hospital admissions due to gastrointestinal events. This finding also suggests that there is room for improvement in the utilization of PPIs for public health protection in Italy.
