Indigestion 'busting NHS budget'

At least ?100m of NHS money and almost ?2bn worldwide is being wasted each year on indigestion drugs, doctors say. In 2006 alone, expenditure on proton pump inhibitors (PPIs) was ?425m in England and ?7bn globally.

Yet in up to 70% of cases there was no indication for the prescription, claim the King's College London experts in the British Medical Journal. They accused doctors of ignoring prescribing guidelines and say cheaper but still effective drugs can be given.

Indigestion, or dyspepsia, is very common and most people have it from time to time. For some people it's very mild - a bout of discomfort after a large meal that goes away on its own or with medicine bought at a pharmacy without a prescription. But for others it can be very frequent and painful and they may need to see a doctor for more powerful medicines.

Proton pump inhibitors like omeprazole are one such drug and work by stopping the stomach from producing acid. But Drs Ian Forgacs and Aathavan Loganayagam say these relatively expensive drugs are being prescribed too readily, contrary to guidance. "Effective and cheaper alternative drugs are available for many patients. Yet prescriptions for proton pump inhibitors have superseded those for all other acid inhibiting agents and now account for over 90% of the NHS drug budget for treating dyspepsia," they told the BMJ.

Dr Forgacs accused hospital doctors of prescribing PPIs too readily and GPs of failing to take patients off the drugs once they are no longer indicated. "Although they are incredibly safe and effective for indigestion, PPIs are being overused. It's a bit like giving morphine for a headache."

In 2000, when the National Institute for Health and Clinical Excellence (NICE) issued its PPI guidance, it said the NHS could save up to ?50m a year in drugs costs in England and Wales by prudent prescribing of these drugs.

Since then, the PPI omeprazole - which makes up 90% of NHS dyspepsia prescriptions - has got cheaper because its patent has expired. This means other drug companies can make generic versions of the branded drug for sale at a fraction of the price.

Dr Richard Stevens, chairman of the Primary Care Society for Gastroenterology, said this might now mean it was cost-effective to prescribe the drugs more frequently. But he cautioned: "We do not want patients taking these drugs unnecessarily. Not all patients require acid suppression."

Although PPIs are safe drugs, they are not without side effects. Research suggests they treble the risk of Clostridium difficile infection, and patients who take PPIs for more than a year are at increased risk of hip fracture.

Chairman of the digestive disorders charity Core Dr John Bennett advised patients with indigestion to look for causes which can easily be remedied, such as over-eating, excess alcohol intake, heavy smoking or rushed meals.

A NICE spokeswoman said: "It is always disappointing when our recommendations are not consistently followed. "For many patients proton pump inhibitors should only be used for a short period of time until the underlying cause of the dyspepsia can be identified and treated. We would strongly urge PCTs to use the criteria set by NICE for prescribing PPIs so that they can be confident they are targeting resources where they are most likely to offer benefit."