Cost of inappropriate antimicrobial use for upper respiratory infection in Japan
Cost of inappropriate antimicrobial use for upper respiratory infection in Japan
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DOI：
10.1186/s12913-020-5021-1
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发表时间：
2020-02-28
影响因子：
2.8
通讯作者：
Ohmagari, Norio
中科院分区：
文献类型：
--
作者：
Tsuzuki, Shinya;Kimura, Yuki;Ohmagari, Norio
背景在门诊护理环境中，抗生素经常不适当地用于上呼吸道感染（URI）患者;然而，此类处方的经济负担尚未进行定量评估。在这里，我们的目的是评估在日本的人口水平上的URI的抗菌药物处方的额外成本。方法采用JMDC理赔数据库中2013 - 2016年的纵向理赔数据进行回顾性观察调查，该数据库包含5个中心100万名65岁以下企业员工及其家属的数据。由6名传染病医生组成的专家组根据JMDC索赔数据库中的ICD-10编码评估抗生素处方的适当性。通过对年龄结构人口数据进行加权，估计了国家一级URI抗生素处方的总额外成本。结果不适当的抗生素处方每年增加的费用估计为423中心点6（95% CI：416中心点8-430中心点5）2013年百万美元，340中心点9（95% CI：335中心点7-346中心点2）2014年百万美元，349中心点9（95% CI：344中心点5-355中心点3）百万美元，2016年为297中心点1（95% CI：292中心点4-301中心点9）百万美元。三类广谱口服抗生素（第三代头孢菌素类、大环内酯类和氟喹诺酮类）占总额外费用的90%以上。结论：虽然观察到了下降的趋势，每年额外的费用不适当的抗生素处方上呼吸道感染可能是一个巨大的经济负担在日本。合理使用广谱口服抗生素可能是日本门诊治疗中减少不必要医疗费用的重要问题。
Background Antibiotics are often prescribed inappropriately to patients with upper respiratory infection (URI) in ambulatory care settings; however, the economic burden of such prescription has not been quantitatively assessed. Here, we aimed to evaluate the additional cost of antimicrobial prescription for URI at the population level in Japan. Methods We conducted a retrospective observational survey using longitudinal claims data between 2013 and 2016 obtained from JMDC Claims Database, which contains data from 5 center dot 1 million corporate employees and family members under the age of 65 years. Appropriateness of antibiotic prescription was assessed by a panel of six infectious disease physicians according to ICD-10 code in JMDC Claims Database. Total additional cost of antibiotic prescription for URI at the national level was estimated by weighting of age-structured population data. Results The annual additional cost of inappropriate antibiotic prescription for URI was estimated at 423 center dot 6 (95% CI: 416 center dot 8-430 center dot 5) million USD in 2013, 340 center dot 9 (95% CI: 335 center dot 7-346 center dot 2) million USD in 2014, 349 center dot 9 (95% CI: 344 center dot 5-355 center dot 3) million USD in 2015, and 297 center dot 1 (95% CI: 292 center dot 4-301 center dot 9) million USD in 2016. Three classes of broad-spectrum oral antibiotics (third-generation cephalosporins, macrolides, and fluoroquinolones) accounted for > 90% of the total additional cost. Conclusions Although a decreasing trend was observed, annual additional costs of inappropriate antibiotic prescriptions for URI could be a substantial economic burden in Japan. Appropriately prescribing broad-spectrum oral antibiotics might be an important issue to reduce unnecessary medical costs in Japanese ambulatory care.