Abstract
In 2013, a change in copayment rate was introduced in the Basque Country (one year later than in the other regions in Spain), and improvements were made to drug packaging. In 2014, a National Program Against Bacterial Resistance (Spanish abbreviation: PRAN) was approved. The aim of this study is to analyze the impact of change to the copayment rate, the adjustment of drug packaging, and the approval of PRAN on the consumption of antibiotics. Raw monthly data on the consumption of antibiotics (costs, packages, and daily defined doses per thousand people (DID)) were collected from January 2009 to December 2018 in the Basque Country. Counterfactual and intervention analysis (Autoregressive integrated moving average (ARIMA) model) was performed for the total series, disaggregated by group of antibiotics (2019 WHO Access, Watch, and Reserve (AWaRe) Classification) and active substances with the highest cost per prescription (cefditoren and moxifloxacin), the lowest cost per prescription (doxycycline and cloxacillin), and the most prescribed active ingredients (amoxicillin, azithromycin, and levofloxacin). Introduction of copayment led to a ‘stockpiling effect’ one month before its implementation, equal to 8% in the three consumption series analyzed. Only the adjustment of drug packaging significantly reduced the number of packages dispensed (−12.19%). PRAN approval reduced consumption by 0.779 DID (−4.51%), representing a significant decrease for both ’access’ and ’watch’ group antibiotics. Despite the delay in implementing changes to copayment, there was a ‘stockpiling effect’. With the adjustment of packaging, fewer packs were prescribed but with a higher drug load and price. PRAN approval reduced both the consumption of ’access group antibiotics’ (first-line treatment) and ’watch group antibiotics’ (second-line treatment).
Highlights
The indiscriminate use of antibiotics accelerates the process of selection and dissemination of bacterial resistance, estimated by the Spanish Society of Infectious Diseases and Clinical Microbiology to lead to 26,000 deaths every year in Spain [1] and to cost €1500 million per year in the EuropeanUnion [2]
This study focuses on the Regional Health Service of the Basque Country, following the recommendation by AEMPS to ensure the exploitation and analysis of data on antibiotics consumption at regional level [23]
The predictions obtained for June 2013, the month prior to implementation of the Royal Decree-Law (RDL), showed an increase in the administration of antibiotics in the series of costs, number of packages and DID, of 8.31%, 7.21%, and 7.44%, respectively
Summary
The indiscriminate use of antibiotics accelerates the process of selection and dissemination of bacterial resistance, estimated by the Spanish Society of Infectious Diseases and Clinical Microbiology to lead to 26,000 deaths every year in Spain [1] and to cost €1500 million per year in the EuropeanUnion [2]. Adjustment of antibiotics packaging (fixing the appropriate number of pills for the most common type of infection), and approval of a National Program Against Bacterial Resistance (PRAN). 16/2012 was introduced in Spain, containing urgent measures to guarantee the sustainability of the National Health System and the quality and safety of its services [3]. Some Autonomous Communities tried to avoid implementing these new pharmaceutical copayments in the belief that the universality of the public health system was not guaranteed. As established by Law 14/1986, in Spain, each Autonomous Community administers a Regional Health Service in order to bring the management of health care closer to the citizen and provide guarantees in terms of equity, quality, and participation [4]. The Autonomous Community of the Basque Country managed to delay the application of RDL until July 2013 through Decree no
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