Effects of County Public Hospital Reform on Procurement Costs and Volume of Antibiotics: A Quasi-Natural Experiment in Hubei Province, China.

The overuse of antibiotics has become a major public health challenge worldwide, especially in low- and middle-income countries, including China. In 2009, the Chinese government launched a series of measures to de-incentivise over-prescription in public health facilities, including decoupling the link between facility income and the sale of medicines. We evaluated the effects of these measures on procurement costs and the volume of antibiotics in county public hospitals. The study was undertaken in the Hubei province of China, where 64 county public hospitals implemented the reform in sequence at three different stages. A quasi-natural experiment design was employed. We performed generalised linear regressions with a difference-in-differences approach using 22,713 procurement records of antibiotics from November 2014 to December 2016. The regression results showed that the reform contributed to a 14.79% increase in total costs for antibiotics (p = 0.013), particularly costs for injectable antibiotics (p = 0.022) and first-line antibiotics (p = 0.030). The procurement prices for antibiotics remained largely comparable to those in the control group, but the reform led to a 17.30% increase in the procurement volume (expressed as defined daily doses) of second-line antibiotics (p = 0.032). County public hospitals procured more antibiotics and greater numbers of expensive antibiotics, such as those administered via injection, to compensate for the loss of income from the sale of medicines, leading to an increased total cost of antibiotics. The online version of this article (10.1007/s40273-018-0654-1) contains supplementary material, which is available to authorized users.

抗生素的过度使用已成为全球范围内的一个重大公共卫生挑战，尤其是在包括中国在内的中低收入国家。2009年，中国政府推出了一系列措施以抑制公共卫生机构的过度开药行为，包括切断机构收入与药品销售之间的联系。 我们评估了这些措施对县级公立医院抗生素采购成本和采购量的影响。 该研究在中国湖北省进行，湖北省64家县级公立医院在三个不同阶段依次实施了改革。采用了准自然实验设计。我们利用2014年11月至2016年12月的22713条抗生素采购记录，采用双重差分法进行了广义线性回归。 回归结果显示，改革导致抗生素总成本增加了14.79%（p = 0.013），尤其是注射用抗生素成本（p = 0.022）和一线抗生素成本（p = 0.030）。抗生素采购价格与对照组基本相当，但改革导致二线抗生素采购量（以限定日剂量表示）增加了17.30%（p = 0.032）。 县级公立医院采购了更多的抗生素以及更多昂贵的抗生素，比如注射用抗生素，以弥补药品销售收入的损失，从而导致抗生素总成本上升。 本文的网络版（10.1007/s40273 - 018 - 0654 - 1）包含补充材料，授权用户可获取。