Effects of economic and health policies on the consumption of antibiotics in a Spanish region

ABSTRACT

Objectives

Inappropriate and indiscriminate use of antibiotics is one of the main factors contributing to the increasing bacterial resistance. Surveillance of antibiotic consumption is fundamental for assessing the effects of rational use-oriented measures introduced under economic or health policies. This study quantifies and assesses the introduction of a pharmaceutical co-payment and implementation of campaigns to increase awareness about and rational use in the consumption of antibiotics (volume and expenditure).

Methods

Monthly official dispensations recorded by a health authority (La Rioja, Spain) between January 2009 and December 2017 (108 observations). Total and disaggregated (by active principle and patient’s income level) time series for a number of packages and expenditure were studied using intervention and counterfactual analyses (Box–Jenkins methodology).

Results

Co-payment reduced the total antibiotic consumption (number of packages −8.52% and expenditure −8.61%) and the difference was greater for the highest-priced antibiotics. Only two of the four campaigns had a significant effect, which lasted 6 months. Counterfactual analysis estimated the savings.

Conclusion

Economic and health policies helped to reduce antibiotic consumption. Each policy has different effects, co-payment reduces overall drug consumption through a price effect (loss of purchasing power), awareness campaigns depend on other elements for their success (media, scope and patient income).

KEYWORDS:

• Antibiotics
• ARIMA model
• awareness campaigns
• co-payment
• rational use campaigns

Article Highlights

• The effects of the co-payment economic policy in terms of pharmaceutical consumption reduction have been analyzed in other Spanish studies but not in the area of antibiotics, which are also affected by health policies, such as awareness and rational use campaigns, whose impact in consumption has scarcely been studied.

• The pharmaceutical co-payment had proved to be the most effective measure for reducing antibiotics consumption, the reduction was greater for higher-priced active principles.

• Awareness and rational use campaigns can reduce antibiotic consumption while avoiding the drawbacks of co-payment for low-income groups, which can cause an inequality effect.

• The high-income population did not respond to the awareness campaigns, which had a greater impact on the low-income group.

• This work contributes to generating information for global action plans on antimicrobial resistance by comparing the effects of both types of policy and identifying key aspects for the success of these measures.

Acknowledgments

The authors thank Professors Carmen Torres Manrique and Roberto Rodríguez Ibeas for their comments and suggestions in the review of the results. The authors thank the Head of the Health Department of the Government of La Rioja for its support and collaboration in this study.

Author contributions

All authors were involved in the conception and design of the study, the analysis and interpretation of the data, the drafting and revising of the paper and the final approval of the version to be published. All authors agree to be accountable for all aspects of the work.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was funded by a predoctoral contract FPI-CAR 2018.