Abstract
Appropriate use of antibiotics is an important strategy to combat the problem of growing antibiotic resistance rates. In order to follow this strategy, it is important to understand the determinants of antibiotic use. We analyse the potential link between competition among general practitioners (GPs) measured with the Herfindahl-Hirshman index (HHI) and regional antibiotic consumption in Norway in 2015 and 2016. We use the data about antibiotic consumption expressed by the number of prescriptions of antibiotics for systemic use (J01) and by the number of antibiotics for respiratory tract infections (phenoxymethylpenicillin (J01CE02), doxycycline (J01AA02), amoxicillin (J01CA04) and macrolides (J01FA)) per 1000 inhabitants. We apply multiple regression analysis to the data mentioned above and control for socioeconomic characteristics of the municipalities. Our findings suggest that competition may contribute to about 37-80 additional antibiotic prescriptions per 1000 inhabitants per year and 23-46 additional prescriptions per 1000 inhabitants of antibiotics for respiratory tract infections. Moreover, our estimations suggest that antibiotic prescription is significantly related to the average number of consultations per patient, the average length of the patient list, travel time to a pharmacy, income, and the share of women.
Highlights
Antibiotic resistance (AR) rates have increased significantly during the last 50 years, making antibiotics less and less effective in treating infectious diseases
Our results suggest that the number of antibiotic prescriptions increases with higher competition
We find a similar relationship if we focus on the analysis of antibiotics for Respiratory Tract Infections (RTIs)
Summary
Antibiotic resistance (AR) rates have increased significantly during the last 50 years, making antibiotics less and less effective in treating infectious diseases. The Fogelberg’s study provides important insights, and the difference-in-difference approach makes it possible to identify the causal effect of the reform on antibiotics prescriptions This approach does not allow measuring the relationship between the level of market concentration and antibiotics use. In contrast to Bennett et al [12], we use aggregated information about all antibiotic prescriptions dispensed by the pharmacies in Norway (which reflects the residential location of the patients) and account for the availability of the health services in different municipalities. Another advantage of or approach is that most antibiotics prescribed by GPs and all antibiotics dispensed by pharmacies in Norway are registered electronically, as well as over-the-counter sales of antibiotics are restricted. This can diminish the effect of the associated confounders in the analysis
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