Small area variations and welfare loss in the use of antibiotics in the community

This paper seeks to explain local variations in the use of antibiotics in the community and to assess the welfare loss due to heterogeneous attitudes towards the risk of bacterial infections and resistance. Significant differences are observed in the per capita antibiotic consumption measured in defined daily doses per 1000 inhabitants (DID) across small geographic areas in Switzerland. A model is proposed in which antibiotic use varies according to the socioeconomic characterisitics of the population characteristics, the incidence of infections, antibiotic price and local supply of health care. Quarterly wholesales data on outpatient antibiotics in 2002 were obtained from IHA-IMS Market Research and combined with WHO standardized doses to obtain DID. The paper finds that the most important determinants of variations in outpatient antibiotics use in the community are income, demographic structure of the population and local supply and price of antibiotic treatment. We estimated that unexplained variations may account for 11% of the total antibiotic spending in the community, thus leading to a C=6ml loss per year.