Purchase and use of antimicrobials in the hospital sector of Vietnam, a lower middle-income country with an emerging pharmaceuticals market.

Vu Quoc Dat,Phan Khanh Toan,H Rogier van Doorn,C Louise Thwaites,Behzad Nadjm,Khin Thet Wai

doi:10.1371/journal.pone.0240830

Abstract

Antimicrobial use is associated with emergence of antimicrobial resistance. We report hospital antimicrobial procurement, as a surrogate for consumption in humans, expenditure and prices in public hospitals in Vietnam, a lower middle-income country with a high burden of drug resistant infections. Data on antimicrobial procurement were obtained from tender-winning bids from provincial health authorities and public hospitals with detailed bids representing 28.7% (1.68 / 5.85 billion US $) of total hospital medication spend in Vietnam. Antimicrobials were classified using the Anatomical Therapeutic Chemical (ATC) Index and the 2019 WHO Access, Watch, Reserve (AWaRe) groups. Volume was measured in number of Defined Daily Doses (DDD). Antimicrobial prices were presented per DDD. Expenditure on systemic antibacterials and antifungals accounted for 28.6% (US $482.6 million/US $1.68 billion) of the total drug bids. 83% of antibacterials (572,698,014 DDDs) by volume (accounting for 45.5% of the antibacterials spend) were domestically supplied. Overall, the most procured antibacterials by DDD were second generation cephalosporins, combinations of penicillins and beta-lactamase inhibitors, and penicillins with extended spectrum. For parenteral antibacterials this was third generation cephalosporins. The average price for antibacterials was US $15.6, US $0.86, US $0.4 and US $11.7 per DDD for Reserve, Watch, Access and non-recommended/unclassified group antibacterials, respectively. Antimicrobials accounted for a substantial proportion of the funds spent for medication in public hospitals in Vietnam. The pattern of antibacterial consumption was similar to other countries. The high prices of Reserve group and non-recommended/unclassified antibacterials suggests a need for a combination of national pricing and antimicrobial stewardship policies to ensure appropriate accessibility.

Highlights

Antimicrobial use is associated with emergence of antimicrobial resistance
Expenditure on systemic antibacterials and antifungals accounted for 28.6% (US $482.6 million/US $1.68 billion) of the total drug bids. 83% of antibacterials (572,698,014 Defined Daily Doses (DDD)) by volume were domestically supplied
Antimicrobials accounted for a substantial proportion of the funds spent for medication in public hospitals in Vietnam

Summary

Methods

Data on antimicrobial procurement were obtained from tender-winning bids from 52/63 provincial health authorities and 30 public hospitals across Vietnam for 2018. The process of bidding for contracts to supply medication to public health facilities follows Vietnamese government guidance [11].The current medication procurement in Vietnam is mostly implemented through bidding which uses a decentralised (individual hospitals directly conduct the procurement) or centralised model (at national level by ministry of health or at provincial level by provincial departments of health, DoHs). At provincial level, centralised procurement involves provincial DoHs gathering procurement needs of provincial and districts hospitals under their jurisdiction, calling for, reviewing and accepting bids. As part of the procurement regulations, the health facility is expected to ensure the consumption of at least 80% of each medication purchased [11]

Results

Discussion

Conclusion