Objectives: To study the clinical effects and costs of a formulary conversion from omeprazole to lansoprazole in the Florida prison system. Methods: Drug utilization patterns were studied before and after the conversion to determine whether the switch reduced drug acquisition cost. In addition, the charts of 29 patients from six sites were reviewed to evaluate the clinical consequences of the conversion. Results: The switch significantly increased (p = 0.006) the need for twice-daily administration, total daily dose from 24.8 mg to 30 mg, and the need for add-on medications to control acid-related symptoms (p = 0.043). Drug acquisition costs rose by nearly $24,000. Conclusions: Formulary conversions based solely on anticipated reductions in drug acquisition costs may not achieve the intended financial savings.
Get full access to this article
View all access options for this article.
References
1.
Blum, R. A., ShiH., Karol, M. D., Greski-Rose, P. A., & Hunt, R. H. (1997). The comparative effects of lansoprazole, omeprazole, and ranitidine in suppressing gastric acid secretion. Clinical Therapeutics, 19, 1013-1023.
2.
Curtiss, F. R. (1996). Drug formularies provide a path to best care. American Journal of Health-System Pharmacy, 53, 2201-2203.
3.
DobrillaG., PiazziL., & FioccaR. (1999). Lansoprazole versus omeprazole for duodenal ulcer healing and prevention of relapse: A randomized, multicenter, double-masked trial. Clinical Therapeutics, 21, 1321-1332.
4.
EkstromP., CarlingL., UngeP., Anker-HansenO., SjostedtS., & SellstromH. (1995). Lansoprazole versus omeprazole in active duodenal ulcer. A double-blind, randomized, comparative study. Scandinavian Journal of Gastroenterology, 30, 210-215.
5.
Flockhart, D. A., DestaZ., & Mahal, S. K. (2000). Selection of drugs to treat gastro-oesophageal reflux disease. The role of drug interactions. Clinical Pharmacokinetics, 39, 295-309.
6.
GiaquintaD. (2001). A view from a managed care provider. Cardiology, 85(Suppl. 1), 30-35.
7.
Hatlebakk, J. G., BerstadA., CarlingL., Svedberg, L. E., UngeP., EkstromP., et al. (1993). Lansoprazole versus omeprazole in short-term treatment of reflux oesophagitis. Results of a Scandinavian multicentre trial. Scandinavian Journal of Gastroenterology, 28, 224-228.
8.
Hatoum, H. T., & AkhrasK. (1993). 1993 bibliography. A 32-year literature review on the value and acceptance of ambulatory care provided by pharmacists. The Annals of Pharmacotherapy, 27, 1106-1119.
9.
HoltS. (1991). Proton-pump inhibition for acid-related disease. The Southern Medical Journal, 84, 1078-1087.
10.
Horn, S. D., Sharkey, P. D., & Phillips-HarrisC. (1998). Formulary limitations and the elderly: Results from the Managed Care Outcomes Project. The American Journal of Managed Care, 4, 1105-1113.
11.
JaspersenD., Diehl, K. L., SchoeppnerH., GeyerP., & MartensE. (1998). A comparison of omeprazole, lansoprazole, and pantoprazole in maintenance treatment of severe reflux oesophagitis. Alimentary Pharmacology & Therapeutics, 12, 49-52.
12.
Jones, D. L., KroenkeK., Landry, F. J., Tomich, D. J., & Ferrel, R. J. (1996). Cost savings using a stepped-care prescribing protocol for nonsteroidal anti-inflammatory drugs. The Journal of the American Medical Association, 275, 926-930.
13.
Lamers, C. B. (1996). The changing role of H2-receptor antagonists in acid-related diseases. European Journal of Gastroenterology & Hepatology, 8(Suppl. 1), S3-S7.
14.
Landes, B. D., Petite, J. P., & FluovatB. (1995). Clinical pharmacokinetics of lansoprazole. Clinical Pharmacokinetics, 28, 458-470.
15.
Levin, T. R., Schmittdiel, J. A., KunzK., Henning, J. M., Henke, C. J., Colby, C. J., et al. (1997). Costs of acid-related disorders to a health maintenance organization. American Journal of Medicine, 103, 520-528.
16.
MehlB., & SantellJ. (2001). Projecting future drug expenditures-2001. American Journal of Health-System Pharmacy, 58, 125-133.
17.
Moore, W. J., & Newman, R. J. (1992). US Medicaid drug formularies: Do they work?. Pharmaco Economics, 1(Suppl. 1), 28-31.
18.
Oatis, G. M., & Stowers, A. D. (2000). Conversion from amlodipine to felodipine ER: Did the change fulfill expectations?. Formulary (Cleveland, Ohio), 35, 435-442.
19.
Regardh, C. G., GabrielssonM., Hoffman, K. J., LofbergI., & SkanbergI. (1985). Pharmacokinetics and metabolism of omeprazole in animals and man-An overview. Scandinavian Journal of Gastroenterology Supplement, 108, 79-94.
20.
Revicki, D. A., WoodM., Maton, P. N., & SorensenS. (1998). The impact of gastroesophageal reflux disease on healthrelated quality of life. American Journal of Medicine, 104, 252-258.
Sanders, S. W. (1996). Pathogenesis and treatment of acid peptic disorders: Comparison of proton pump inhibitors with other antiulcer agents. Clinical Therapeutics, 18, 2-34.
