Marked increase in proton pump inhibitors use in Australia

Pharmacoepidemiol Drug Saf. 2010 Oct;19(10):1019-24. doi: 10.1002/pds.1969.


Objectives: To examine the trends in the prescribing of subsidized proton pump inhibitors (PPIs) and histamine receptor antagonists (H2RAs), in the Australian population from 1995 to 2006 to encourage discussion regarding appropriate clinical use. PPIs and H2RAs are the second highest drug cost to the publicly subsidized Pharmaceutical Benefits Scheme (PBS).

Design: Government data on numbers of subsidized scripts, quantity and doses for PPIs and H2RAs were analysed by gender and age, dose and indication.

Main outcome measure: Drug utilisation as DDD [defined daily dose]/1000 population/day.

Results: The use of combined PPIs increased by 1318%. Utilisation increased substantially after the relaxation of the subsidized indications for PPIs in 2001. Omeprazole had the largest market share but was substituted by its S-enantiomer esomeprazole after its introduction in 2002. There was considerable use in the elderly with the peak use being in those aged 80 years and over. The utilisation of H2RAs declined 72% over 12 years.

Conclusions: PPI use has increased substantially, not only due to substitution of H2RAs but to expansion in the overall market. Utilisation does not appear to be commensurate with prevalence of gastro-oesophageal reflux disease (GORD) nor with prescribing guidelines for PPIs, with significant financial costs to patients and PBS. This study encourages clinical discussion regarding quality use of these medicines.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Australia
  • Child
  • Child, Preschool
  • Drug Costs
  • Drug Utilization
  • Female
  • Gastroesophageal Reflux / drug therapy
  • Gastroesophageal Reflux / economics
  • Gastrointestinal Agents / economics
  • Gastrointestinal Agents / therapeutic use
  • Heartburn / drug therapy
  • Heartburn / economics
  • Histamine H2 Antagonists / economics*
  • Histamine H2 Antagonists / metabolism
  • Histamine H2 Antagonists / therapeutic use*
  • Humans
  • Male
  • Middle Aged
  • Pharmacopoeias as Topic
  • Practice Patterns, Physicians' / economics
  • Proton Pump Inhibitors / economics*
  • Proton Pump Inhibitors / metabolism
  • Proton Pump Inhibitors / therapeutic use*
  • Young Adult


  • Gastrointestinal Agents
  • Histamine H2 Antagonists
  • Proton Pump Inhibitors