Impact of an IV proton pump inhibitor restriction policy on prescribing patterns and estimated drug cost.

Introduction: Intravenous (IV) proton pump inhibitors (PPIs) are commonly used in hospitalized patients, although a substantial proportion of this use may be inappropriate, particularly when enteral therapy is feasible. Restriction policies may help optimize prescribing and reduce unnecessary drug costs. This study evaluated the impact of an IV PPI restriction policy on prescribing patterns and estimated direct drug cost at a regional secondary care hospital in Saudi Arabia. Methods: This retrospective before-and-after study was conducted from April 2023 to April 2024. The pre-restriction period was April to September 2023, and the post-restriction period was November 2023 to April 2024; October 2023 was excluded as the implementation washout month. Monthly hospital pharmacy records were used to collect IV and oral PPI prescriptions and recorded units, and prescribing and cost outcomes were normalized per 100 inpatient admissions. Clinical outcomes were not assessed. Pre- and post-restriction monthly values were compared using the Mann-Whitney U test. Results: After policy implementation, mean monthly IV PPI prescriptions per 100 inpatient admissions decreased from 92.1 to 37.8, a 59.0% reduction (p = 0.0131), whereas oral PPI prescriptions increased from 15.5 to 41.6 per 100 inpatient admissions, a 169.2% increase (p = 0.0202). Total PPI prescriptions decreased from 107.6 to 79.3 per 100 inpatient admissions, a 26.2% reduction (p = 0.0082). The proportion of IV PPI prescriptions declined from 85.6% to 45.0% (p = 0.0152). Mean estimated total PPI drug cost per 100 inpatient admissions decreased from 3,534.6 to 1,642.9 SAR, a 53.5% reduction (p = 0.0131). Conclusion: Implementation of an IV PPI restriction policy was associated with lower IV PPI prescribing, increased oral PPI use, and lower estimated direct drug cost. Clinical safety and efficacy were not evaluated and require further investigation.