Fazaludeen Koya Shaffi, Ganesh Senthil, Klemperer Katherine, Yadav Prashant, McDonnell Anthony
Boston University School of Public Health, Boston, Massachusetts, 02125, USA.
Public Health Foundation of India, New Delhi, Delhi, India.
Wellcome Open Res. 2024 Feb 19;9:70. doi: 10.12688/wellcomeopenres.20633.1. eCollection 2024.
Consumption of injectable antibiotics is not widely studied, despite injectables constitute a major share of antibiotic cost. This study aimed to understand the share of oral and injectable antibiotic consumption and cost at the national level in India, and the public and private sector shares in the provision and cost of injectables in Kerala state.
We used the PharmaTrac private sector sales dataset and the Kerala Medical Services Corporation public sector procurement dataset. Using WHO Access, Watch, Reserve (AWaRe) and Anatomical Therapeutic Chemical (ATC) Classifications, we estimated the annual total and per-capita consumption, and the annual total, per defined daily dose (DDD), and per-capita spending on injectables.
Although 94.9% of total antibiotics consumed at the national level were oral preparations, 35.8% of total spending were on injectables. In Kerala , around 33% of total antibiotic spending in the private sector were for injectables, compared to around 25% in the public sector. The public sector used fewer injectable antibiotic formulations (n=21) compared the private sector (n=69). The cost per DDD was significantly higher in the private sector as compared to the public sector. Despite only accounting for 6.3% of the cost share, the public sector provided 31.4% of injectables, indicating very high efficiency. Across both sectors, Watch group antibiotics were significantly more consumed and at a significantly higher cost than Access group antibiotics, for example in nearly double the quantity and at 1.75 times the price per DDD in the private sector. Reserve group antibiotics made up the lowest consumption share (0.61% in the private sector), but at the highest cost per DDD (over 16 times that of Access).
Public sector showed higher cost efficiency in antibiotic provisioning compared to private sector. Appropriate antibiotic use cannot be achieved through drug price control alone but requires extensive engagement with private providers through structured stewardship programs.
尽管注射用抗生素占抗生素成本的很大一部分，但对其消费情况的研究并不广泛。本研究旨在了解印度全国口服和注射用抗生素的消费及成本占比，以及喀拉拉邦公共和私营部门在注射用抗生素供应及成本方面的占比。
我们使用了PharmaTrac私营部门销售数据集和喀拉拉邦医疗服务公司公共部门采购数据集。利用世界卫生组织的“准入、监测、储备”（AWaRe）和解剖治疗学化学（ATC）分类，我们估算了年度总消费量和人均消费量，以及注射用抗生素的年度总支出、每限定日剂量（DDD）支出和人均支出。
尽管全国层面消费的抗生素总量中有94.9%为口服制剂，但注射用抗生素的支出占总支出的35.8%。在喀拉拉邦，私营部门抗生素总支出中约33%用于注射用抗生素，而公共部门这一比例约为25%。与私营部门（69种）相比，公共部门使用的注射用抗生素制剂较少（21种）。私营部门每DDD的成本显著高于公共部门。尽管公共部门仅占成本份额的6.3%，但其提供了31.4%的注射用抗生素，表明效率非常高。在两个部门中，“监测”组抗生素的消费量显著高于“准入”组抗生素，且成本也显著更高，例如在私营部门，“监测”组抗生素的数量几乎是“准入”组的两倍，每DDD的价格是其1.75倍。“储备”组抗生素的消费占比最低（私营部门为0.61%），但每DDD的成本最高（超过“准入”组的16倍）。
与私营部门相比，公共部门在抗生素供应方面表现出更高的成本效率。仅通过药品价格控制无法实现合理使用抗生素，还需要通过结构化管理计划与私营供应商广泛合作。
