Dyspepsia Impact On Primary Care

1. Dyspepsia Impact On Primary Care Dr Paul Pickering GP, Bridlington Prescribing Lead YW&C PCT

2. Overview The scale of the problem in primary care The cost of dyspepsia Practice-based dyspepsia clinics

3. The Scale of the Problem Dyspepsia prevalence 40% population National data shows 3-5% population present to their GP with symptoms Consultation rates of 355 per 10000 pt yrs at age 25-44 to 789 per 10000 pt yrs at age 75-84 Population surveys imply 10% seek assistance from their GP 1% population referred for endoscopy Discrepancy between national data and population surveys due to a combination of factors including pt recall and correct clinical coding of reasons for consultationDiscrepancy between national data and population surveys due to a combination of factors including pt recall and correct clinical coding of reasons for consultation

4. GI Drug Spend NHS GI drug spend is �1.26 billion(71% increase in 2 years) Source IMS BPI December 2002 GI represents 16% NHS drug budget NHS GI drug spend is �1.26 billion(71% increase in 2 years) Source IMS BPI December 2002 GI represents 16% NHS drug budget

5. Cost of Dyspepsia �1.2 billion/yr with a cost growth of 8-9% 19 million prescriptions for PPIs PPIs account for 34% of the volume but 83% of the NHS upper GI spend Alginates are 41% of the volume and 4% of the NHS upper GI spend 40% of PPIs are being prescribed to long term users Maintenance dose PPI represents the minority NHS GI prescribing spend: source IMS BPI Dec 02 Note numbers above relate to NHS budget add further�130M on endoscopies(2000)NHS GI prescribing spend: source IMS BPI Dec 02 Note numbers above relate to NHS budget add further�130M on endoscopies(2000)

6. Cost of Dyspepsia Source IMS Health-MAT to Feb 2003 PPIs are 34% volume and 83% spend Alginates are 41% volume and 4% of spend Cost PPIs up 9.3% alginates down 1.1% Volume PPIs up 12.6% alginates down 0.7% Source IMS Health-MAT to Feb 2003Source IMS Health-MAT to Feb 2003 PPIs are 34% volume and 83% spend Alginates are 41% volume and 4% of spend Cost PPIs up 9.3% alginates down 1.1% Volume PPIs up 12.6% alginates down 0.7% Source IMS Health-MAT to Feb 2003

7. Cost of Dyspepsia Recorded reasons for long term PPI use Oesophagitis(2) 17% Reflux 40% Non-specific dyspepsia 30% Peptic ulcer disease 3% Oesophageal ulcer/stricture 2% Non-GI problems 1% Ref: (1) BNF September 2003, (2) Hungin APS, Rubin GP et al, 1999: Martin RM, Lim AG, 1998: Bashford JH, Norwood J, 1998 Findings at endoscopy British Society of Gastroenterology revised April 2002: 30% normal/30% HH,gastritis,duodenitis/10-17% oesophagitis/10-15%DU/5-10%GU/2%oesophageal-gastric cancerRef: (1) BNF September 2003, (2) Hungin APS, Rubin GP et al, 1999: Martin RM, Lim AG, 1998: Bashford JH, Norwood J, 1998 Findings at endoscopy British Society of Gastroenterology revised April 2002: 30% normal/30% HH,gastritis,duodenitis/10-17% oesophagitis/10-15%DU/5-10%GU/2%oesophageal-gastric cancer

8. Cost of Dyspepsia Findings at endoscopy Normal 30% Mild inflammation/HH 30% Oesophagitis 10-17% Malignancy 2-3% DU 10-15% GU 5-10% Stats from BS of Gastroenterology revised Apr 2002. NICE new document in discussion presently states 60% endoscopies are normal.Stats from BS of Gastroenterology revised Apr 2002. NICE new document in discussion presently states 60% endoscopies are normal.

9. National GORD Data