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JAC Advance Access originally published online on October 29, 2003
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Journal of Antimicrobial Chemotherapy (2003) 52, 1001-1004
© 2003 The British Society for Antimicrobial Chemotherapy

Modelling of escalating outpatient antibiotic expenditures

Elias Zintzaras1,2 and John P. A. Ioannidis1,3,*

1 Clinical and Molecular Epidemiology Unit and Clinical Trials and Evidence-Based Medicine Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina 45110; 2 Biomathematics Unit, University of Thessaly School of Medicine, Larissa 41222, Greece; 3 Division of Clinical Care Research, Department of Medicine, Tufts University School of Medicine, Boston, MA 02111, USA

Received 27 February 2003; returned 6 May 2003; revised 13 May 2003; accepted 1 September 2003

Objectives: To model the relative role of old and newly introduced antibiotics in shaping increased antibiotic use.

Methods: Grouped data covering nationwide consumption and expenditure for out-of-hospital antibiotics in Greece (1990–1999) were used. The antibiotic formulations were categorized into ‘common old formulations’, ‘old formulations with intermittent sales’, ‘recast formulations’ and ‘new substances’. The effect of each category was investigated based on index and pricing analyses.

Results: We estimated a 143% net increase in out-of-hospital antibiotic use during 1990–1999. The increase was 59% when all formulations of antibiotic substances available by 1990 were considered. A rapid turnaround of formulations of old substances was noticed with 669 formulations marketed during the decade. Sixteen new antibiotic substances were first introduced after 1990 and by 1999 they accounted for 34.9% of total out-of-hospital antibiotic expenditures. Three new antibiotics (a macrolide and two cephalosporins) accounted for over 90% of this amount. For all three, other less expensive alternatives were available.

Conclusions: In the studied setting, out-of-hospital antibiotic use has been expanding in a highly substance-specific and non-rational fashion that is accelerated by the introduction of new drugs.

Keywords: antibiotic use, expenditure, model

* Corresponding author. Tel: +30-26510-97807; Fax: +30-26510-97867; E-mail: jioannid{at}cc.uoi.gr


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