Abstract
Background: Overuse of antibiotics may not only increase the burden of antimicrobial resistance, but also accelerate the growth of healthcare expenditures. China has issued a series of policies to improve antibiotic use and reduce the cost of medicine in healthcare institutions. This study aimed to evaluate the trends of antibiotic expenditure in public healthcare institutions in Shandong from 2012 to 2016 and to assess antibiotic expenditure by drug class and the level of healthcare institutions.Methods: We collected data from the centralized bidding procurement (CBP) system in Shandong province between 2012 and 2016. Governmental health facilities including secondary and tertiary hospitals, and urban and rural primary healthcare centers (PHCs) procured antibiotics via this system. Antibiotics were classified according to the Anatomical Therapeutic Chemical (ATC) classification system. Antibiotic expenditure was assessed using total annual expenditure (US dollars) and expenditure per person per year (US dollars).Results: The overall antibiotic expenditure was $717 million in 2016, a 56% increase compared to 2012. Parenteral antibiotics accounted for 84% of the total antibiotic expenditure in 2016. Most of the antibiotics were procured by secondary and tertiary hospitals (33 and 44%, respectively). The expenditures continuously increased in secondary hospitals, tertiary hospitals, and urban PHCs from 2012 to 2016, while antibiotic procurement decreased in urban PHCs since 2015. The third-generation cephalosporins (J01DD) were among the top five ATC classes of antibiotics in all healthcare institutions. Fluoroquinolones (J01MA) were commonly procured by tertiary hospitals, rural and urban PHCs. The expenditure on carbapenems (J01DH) raised sharply in tertiary hospitals.Conclusions: The overall antibiotic expenditure kept increasing in the public healthcare institutions in Shandong. The trends of increasing expenditure began to decline in 2016, which may be associated with antibiotic stewardship initiatives. The expenditure for expensive and critical important classes of antibiotics increased, therefore it is of importance to develop policies on improving the rational use of antibiotics.
Highlights
Attention is being drawn to antimicrobial resistance (AMR)
The main aim of this study was to explore trends of antibiotic expenditure at public healthcare institutions in Shandong, over a 5-year period, using antibiotic procurement data collected from Shandong CBP system
Tertiary hospitals and urban primary healthcare centers (PHCs), which are often located in urban areas, expenditure continued to increase during the study period
Summary
Attention is being drawn to antimicrobial resistance (AMR). AMR has posed a serious threat to human health and to economic and social development. In China, national health expenditure sharply increased from $423 billion (based on the value of 1 US$ = 6.64 RMB in 2016) in 2012 to $698 billion in 2016 (National Health Family Planning Commission, 2017a). This increase was partly driven by the expansion of healthcare coverage and partly due to the growth of unnecessary or inappropriate health services such as the use of medicines and tests (Liang et al, 2014). China has issued a series of policies to improve antibiotic use and reduce the cost of medicine in healthcare institutions. This study aimed to evaluate the trends of antibiotic expenditure in public healthcare institutions in Shandong from 2012 to 2016 and to assess antibiotic expenditure by drug class and the level of healthcare institutions
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