Using oral and parenteral formulation of AWaRe antibiotics as a proxy estimate of community and hospital healthcare sector use

Abstract

Background: Benchmarking antibiotic use across different healthcare sectors is crucial to improve use and implement the United Nations General Assembly 70% Access target. Many countries only have available aggregate sales data, which do not have sector-specific usage information. The objective of this study is to estimate the proportion of oral and parenteral antibiotic use across different healthcare sectors. Materials and methods: We used IQVIA MIDAS^® Quarterly Sales data and Global Point Prevalence Survey (Global-PPS) hospital healthcare data from eight countries, including Belgium, Canada, China, Netherlands, Philippines, Saudi Arabia, Singapore and the UK, in 2019. Our analysis focused on Access and Watch antibiotics. In the main analysis, we assumed that all parenteral antibiotics were used exclusively in hospital healthcare settings, an assumption we then relaxed through sensitivity analyses. The observed ratios of oral-to-parenteral antibiotics in the patient-level Global-PPS data were calculated, by dividing the volume of oral antibiotic use by that of parenteral antibiotic use, and then this calculated ratio was multiplied by the IQVIA MIDAS sales data to estimate oral antibiotic use outside of the hospital healthcare sector. Results: The ratios of oral-to-parenteral use among hospital healthcare sectors in the Global-PPS data ranged between 0.05 [95% credible interval (CrI): 0.03–0.09] and 1.01 (95%CrI: 0.56–1.80) in the main analysis. We estimated that overall, <7% of national oral antibiotics were used by hospital healthcare sectors, assuming exclusive parenteral use in hospital healthcare settings in the main analysis, and <9% when assuming 90% of parenteral use was hospital healthcare in the sensitivity analyses. Conclusion: Our results indicate that where patient-level data are unavailable, alternative sources, such as antibiotic procurement and supply data including routes of administration, can reasonably estimate sector-specific national use.