Patient population parameters were similar during the time periods before and after the formulary switch (Table 1). Usage analyses, unadjusted for patient-days, indicated that after the formulary switch (Table 2):

  • the number of PPI doses intended for patients tolerating oral intake increased by 31%.
  • the number of PPI doses intended for enteral tube administration increased by 192%.
  • the number of IV PPI doses increased by 168%.
  • the number of enteral H2RAs doses increased by only 21%.
  • the number of IV H2RA doses decreased by 7%.

Table 1 Hospital Patient Population Parameters for Six-Month Time Periods Before and After a PPI Formulary Switch

Variable Before Switch (Jan.-June, 2004)

After

Switch (Jan.-June, 2005)

Total discharged,all (n)

9,369

10,436

Non-ICU (n)

8,941

9,951

ICU (n)

428

485

Discharged per ICU (n)
MICU/CCU

216

226

SICU

53

75

Burn/trauma ICU

98

91

NSICU

61

93

Total patient-days,all (n)

45,720

52,787

Non-ICU

43,015

49,349

ICU

2,705

3,438

Median length of stay

4.9 days

5.1 days

All
Non-ICU

4.8 days

5.0 days

ICU

6.3 days

7.1 days

Case-mix index,all

1.3726

1.3523

Non-ICU

1.3024

1.2729

ICU

2.8399

2.9824

* All comparisons are nonsignificant.CCU = coronary/cardiac care unit; ICU = intensive care unit; MICU = medical intensive care unit; NSICU = neurosurgical intensive care unit; SICU = surgical intensive care unit.

Similar results were obtained when usage was adjusted for patient-days (Table 3):

  • The total number of PPI doses increased by 38%.
  • The number of enteral PPI doses increased by 25%.
  • The number of IV PPI doses increased by 132%.
  • The total number of H2RA doses decreased by 5%.
  • The number of enteral H2RA doses increased by only 5%.
  • The number of IV H2RA doses decreased by 19%.

In relation to non-ICU usage, with adjustments made for patient-days, the likelihood of PPI use in the ICUs was 2.51 times higher after the formulary switch (95% CI, 2.05-3.07; P < .0001). This was equally represented by the probability of enteral use increasing by 2.64-fold (95% CI, 2.11-3.30; P < .0001) and IV use increasing by 2.11-fold. The CI was nonexistent, because non-ICU usage was negligible before and after the formulary change.

Table 2 Usage Parameters Unadjusted for Patient-Days before and after a Formulary Switch

Before

After

Switch Switch
(Jan.-June (Jan.-June
Units Charged 2004)

2005)

5,701

0

20 mg, 40 mg (n)
f 5,161

14,273

15 mg, 30 mg (n)
Lansoprazole suspension*(n) 1,004

0

Canadian Lansoprazole disintegrating 0

2,928

tabletsf 15 mg, 30 mg (n)
Pantoprazole IV* 1,544

0

40 mg (n)
Lansoprazole IVf 0

4,143

30 mg (n)
f 8,468

10,514

150 mg (n)
Canadian Ranitidine solution*! 393

242

150 mg/10 ml (n)

In contrast, the likelihood of H2RA use in the ICU, in relation to non-ICU use after the formulary switch, decreased by 0.49 fold (95% CI, 0.39-0.61; P < .0001), with the probability of enteral use decreasing by 0.24-fold (95% CI, 0.17-0.35; P < .0001) and IV use decreasing by 0.73-fold. The CI was nonexistent, because non-ICU usage was negligible before and after formulary change.

Relative to H2RA use, with adjustments made for patient-days:

  • The overall likelihood of using PPIs after the formulary switch increased by 1.46-fold (95% CI, 1.17-1.82; P < .0001).
  • The probability of use of PPIs in the ICU increased by 3.03-fold (95% CI, 2.75-3.35; P < .0001).
  • The probability of use of PPIs in non-ICU sites decreased by 0.59-fold (95%% CI, 0.44-0.74; P < .0001).

Table 3 Usage and Cost Parameters of PPIs and H2RAs Adjusted for Patient-Days and Hospital Location before and after a Formulary Switch

Before

After

Switch

Switch

(Jan.-June,

(Jan.-June,
Parameter

2004)

2005)

Enteral PPI units/

0.260

0.326

total patient-days
Non-ICU

0.253

0.220

ICU

0.371

0.852

IV PPI units/l

0.034

0.079

total patient-days
Non-ICU

ICU

0.571

1.205

Total PPI units/

0.293

0.404

total patient-days
Non-ICU

0.253

0.220

ICU

0.942

2.056

Enteral H2RA units/

0.194

0.203

total patient-days
Non-ICU

0.145

0.213

ICU

0.197

0.070

IV H2RA units/

0.151

0.122

total patient-days
Non-ICU

ICU

2.550

1.869

Total H2RA units/

0.345

0.326

total patient-days
Non-ICU

0.145

0.213

ICU

2.695

1.939

PPI cost/total patient-days

0.51

0.52

(cost in $/day)
Non-ICU

0.06

0.07

ICU

7.69

7.00

Total cost/total patient-days

0.65

0.59

Days (cost in $/day)
Non-ICU

0.08

0.09

ICU

9.66

7.80

* Comparisons using odds ratios obtained from 2 x 2 contingency
tables are presented in the text.
ICU = intensive care unit; PPI = proton pump inhibitor;
H2RA = histamine2-receptor antagonist. Key: — = negligible.

The total cost of PPI therapy adjusted for patient-days was similar before and after the formulary change (see Table 3). Relative to non-ICU PPI costs, the cost of PPIs in the ICU was unaltered after the switch, with an odds ratio of 0.78 (95% CI, 0.54-1.36; P = .18). Taking into account H2RA therapy, the overall cost of acid-suppressant therapy was reduced by 0.72-fold in the ICU relative to non-ICU locations (95% CI, 0.52-1.00; P = .04). canadian pharmacy viagra