A cross national study was undertaken comparing utilisation and expenditure of PPIs in ambulatory care among 18 European countries. Utilisation increased across all countries despite effective drugs to treat h. pylori, programmes to encourage maintenance doses and concerns with prescribing indications. Omeprazole generally dominated PPI utilisation especially following generic availability. PPI costs (?/ DDD decreased with increasing use of generic PPIs helping to moderate and in some cases reduce PPI expenditure. Cost/ DDD for generic omeprazole varied widely depending on for instance compulsory generic substitution and the extent of demand side initiatives. Opportunity for clinical pharmacologists and others to further improve the quality and efficiency of PPI prescribing especially given the extent of expenditure for no appropriate indication.
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