Improving antibiotic use has the potential to decrease health care costs by reducing the incidence of antibiotic-resistant infections, antibiotic-associated adverse events, and expenditures due to unnecessary prescriptions. We first reported that antibiotic expenditures totaled $10.7 billion in 2009 in the United States. The purpose of this study was to assess overall and class-specific antibiotic costs by health care setting in the United States between 2010 and 2013.
Systemic antibiotic expenditures from January 2010-December 2013 were extracted from IMS Health© National Sales Perspectives database. These data represent a statistically valid projection of inpatient and outpatient medication purchases in the U.S.
RESULTS: Antibiotic expenditures totaled $38.0 billion over the study period; expenditures in 2013 ($9.2 billion) were 13.3% lower than in 2010 ($10.6 billion). The majority (60.4%; $22.9 billion) of expenditures were associated with the outpatient setting; 89.8% of outpatient expenditures were in community pharmacies. Non-federal hospitals accounted for 29.1% of expenditures. From 2010 to 2013, the largest growth in antibiotic expenditures occurred in mail order pharmacies (71.3% increase) and clinics (39.9% increase). The antibiotic class accounting for the largest proportion of antibiotic expenditures overall was the tetracyclines, followed by penicillins, cephalosporins, and macrolides. The majority of expenditures for tetracyclines (83.8% of tetracycline expenditures), sulfamethoxazole/trimethoprim (74.6%), macrolides (73.7%), quinolones (73.3%), and cephalosporins (65.2%) were in community pharmacies.
The outpatient setting, especially community pharmacies, are where most (>60%) antibiotic expenditures are incurred. Outpatient antibiotic expenditures are likely a very conservative estimate of the relative contribution to U.S. antibiotic consumption, as intravenous formulations are more expensive than oral formulations. Other countries with comprehensive use data have reported that 90% of antibiotic use is in the outpatient setting. These results suggest an opportunity for antimicrobial stewardship efforts to reduce drug expenditures.
R. M. Roberts, None
R. Hunkler, Ims health: Employee , Salary
L. Matusiak, Ims health: Employee , Salary
G. Schumock, Abbvie: Consultant and Grant Investigator , Consulting fee and Grant recipient
Baxter: Consultant and Grant Investigator , Consulting fee and Grant recipient
Merck: Consultant and Grant Investigator , Consulting fee and Grant recipient
Transdermal therapeutics: Consultant and Grant Investigator , Consulting fee and Grant recipient
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