Determinants of outpatient antibiotic consumption in Europe: bacterial resistance and drug prescribers

This paper investigates socioeconomic determinants of outpatient antibiotic consumption in Europe. Comparable data on antibiotic use measured in the defined daily doses per 1000 inhabitants (DID) are currently provided by the ESAC project. Results from applied econometric estimations for panel data reveal a link between antibiotic use and the per capita income, the demographic structure of the population, the level of education and cultural aspects. Supply-side factors, such as the density of providers and their remuneration methods, are also considered. We provide the first estimate of the impact of bacterial resistance on consumption when the e?ect of other determinants is simultaneously taken into account.Antibiotic use, Cross-country variations, Bacterial resistance, Supply-induced demand

Socioeconomic determinants of outpatient antibiotic use in Europe

Objectives: Outpatient antibiotic consumption widely varies across Europe. The investigation of the causes of such variation may help to identify interventions that would improve the efficient use of antibiotics. The aim of this study was to assess the impact of socioeconomic determinants and the role played by information about bacterial resistance. Methods: Comparable data on systemically administered antibiotics and socioeconomic determinants in 17 European countries were available between 2000 and 2005. We estimated an ad hoc econometric model by means of a hybrid log-log functional form and random effects generalised least squares regressions. Lagged values and the instrumental variable method were applied to address endogeneity of bacterial resistance and infections. Bacterial resistance was measured by the rate of penicillin non-susceptible Streptococcus pneumoniae isolates (PNSP) and methicillin-resistant Staphylococcus aureus (MRSA). Results: The population income, demographic structure, density of general practitioners and their remuneration method appeared to be significant determinants of antibiotic consumption. Although countries with higher levels of bacterial resistance exhibited significantly higher levels of per capita antibiotic use, ceteris paribus, the responsiveness of antibiotic use to changes in bacterial resistance was relatively low (0.09-0.18). Conclusions: The study confirms that socioeconomic factors should be taken into account while explaining differences in outpatient antibiotic use across countries. The impact of supply-side factors and incentives attached to payment schemes for physicians need to be considered in government interventions to reduce inequalities and improve effectiveness in antibiotic utilisatio

Antibiotic use in ambulatory care in Europe (ESAC data 1997-2002) : trends, regional differences and seasonal fluctuations

Purpose: The ESAC project (European Study on Antibiotic Consumption) aims to collect antibiotic-use data through a European network of national surveillance systems. This paper reports on the retrospective data collection in ambulatory care for the period 1997–2002. Methods: Valid data of antibiotic consumption of 24 European countries for 2002 and of 18 countries for the entire 6-year period was classified according to the Anatomical Therapeutic Chemical Classification (ATC) and expressed in defined daily dose (DDD) per 1000 inhabitants per day (DID). Overall and subgroup comparison of antibiotic consumption over time as well as between geographical clusters was performed. Results: Total use of antibiotics in Europe remained at a median level of 20 DID in the period 1997–2002 with a wide variation between countries ranging from 9.8 DID in The Netherlands to 32.2 DID in France. A substantial increase in subclass consumption of co-amoxiclav and fluoroquinolones was noted while the use of narrow-spectrum penicillins, erythromycin, quinolones and sulfonamides decreased. Total consumption as well as seasonal fluctuations showed remarkable geographical clustering with low consumption and low variation between summer and winter in the North, high consumption patterns in the South and a mixed model in the East. Conclusions: Within the ESAC project, valid time series of antibiotic-use data are publicly available now, enabling to improve the study of determinants of use, the evaluation of governmental antibiotic consumption policies and the investigation of the associated emergence of antibiotic resistance.peer-reviewe

Comparison of outpatient systemic antibacterial use in 2004 in the United States and 27 European countries

The European Surveillance of Antimicrobial Consumption (ESAC) project collects data on antibacterial use in Europe, applying the Anatomic Therapeutic Chemical classification system and defined daily dose methodology, as recommended by the World Health Organization. Comparable data for the United States have been collected from IMS Health. The IMS Health sales data, processed according to ESAC methodology, suggest that outpatient antibacterial use in the United States is high (only 3 of 27 European countries used more) and is mainly characterized by a shift towards newer antibiotics.peer-reviewe

Antimicrobial Drug Use and Resistance in Europe

Routine surveillance data indicate a relation between use and resistance and support interventions designed to reduce antimicrobial consumption at a national level in Europe

Antimicrobial drug use and resistance in Europe

Our study confronts the use of antimicrobial agents in ambulatory care with the resistance trends of 2 major pathogens, Streptococcus pneumoniae and Escherichia coli, in 21 European countries in 2000–2005 and explores whether the notion that antimicrobial drug use determines resistance can be supported by surveillance data at national aggregation levels. The data obtained from the European Surveillance of Antimicrobial Consumption and the European Antimicrobial Resistance Surveillance System suggest that variation of consumption coincides with the occurrence of resistance at the country level. Linear regression analysis showed that the association between antimicrobial drug use and resistance was specific and robust for 2 of 3 compound pathogen combinations, stable over time, but not sensitive enough to explain all of the observed variations. Ecologic studies based on routine surveillance data indicate a relation between use and resistance and support interventions designed to reduce antimicrobial drug consumption at a national level in Europe.peer-reviewe

Lekova politika a spotreba leciv v zemich Visegradske skupiny.

The Czech Republic, Slovakia, Poland and Hungary, countries with similar political and economical background, have been moving away from centralised, command-and-control, healthcare systems to more decentralised market-responsive ones based on social insurance model and the pattern of their drug consumption is changing simultaneously to: imports were liberalised, number of available products previously restricted has rapidly grown, mainly because of the registration of foreign products; the Soviet Union, the traditional export market, collapsed, marketing became an important concept for local producers; product patent law had to be introduced neutralising the capacity to reproduce original medicines by different technological processes; demand for GMP meant a rationalisation and updating of plants, causing prices to soar; prescribers were not prepared for the wide range of new products available and were easily susceptible to modern marketing techniques; increased consumer expectation and creation of new insurance schemes covering broad scope of medicines have pushed up pharmaceutical cost. These four countries have combined population of about 65 million and area of 533 thousand km2. Their total market for pharmaceuticals was valued at around USD 4,3 billion at manufacturer prices.Available from STL Prague, CZ / NTK - National Technical LibrarySIGLECZCzech Republi

Socio-economic determinants of outpatient antibiotic consumption in Europe

Outpatient antibiotic consumption widely vary across Europe. The investigation of what lies behind such variation may help to identify sources of inefficiency. Comparable data on antibiotic use in 21 European countries between 1997 and 2005 are provided by the European Surveillance of Antimicrobial Consumption (ESAC). Data on determinants are available for 17 countries between 2000 and 2005. We estimate an ad-hoc econometric model to assess the impact of socio-economic determinants of antibiotic consumption and the role played by bacterial resistance knowledge. The population income, the demographic structure, the density of general practitioners and their remuneration method appear to be significant determinants of antibiotic consumption. Although countries with higher levels of bacterial resistance exhibit significantly higher levels of per capita antibiotic use, ceteris paribus, the responsiveness of antibiotic use to changes in bacterial resistance is relatively low (0.009-0.015). This may suggest that the dissemination of information on bacterial resistance across Europe lacks effectiveness. Next to guidelines on appropriate use of antibiotics and awareness campaigns, economic incentives to general practitioners may provide opportunities for additional policy instruments to increase efficiency in antibiotic consumption.Antibiotic use. Cross-country variations. Bacterial resistance

Determinants of outpatient antibiotic consumption in Europe: bacterial resistance and drug prescribers

This paper investigates socioeconomic determinants of outpatient antibiotic consumption in Europe. Comparable data on antibiotic use measured in the defined daily doses per 1000 inhabitants (DID) are currently provided by the ESAC project. Results from applied econometric estimations for panel data reveal a link between antibiotic use and the per capita income, the demographic structure of the population, the level of education and cultural aspects. Supplyside factors, such as the density of providers and their remuneration methods, are also considered. We provide the first estimate of the impact of bacterial resistance on consumption when the effect of other determinants is simultaneously taken into account