The PediCAP health economics analysis team presented preliminary results of an analysis to estimate the global consumption and costs of two commonly used antibiotics for managing childhood infections in community settings: amoxicillin and co-amoxiclav. Both are classified as Access antibiotics for pediatric respiratory infections in the WHO EMLc, but despite higher cost, robust data to support the additional clinical benefit of co-amoxiclav in primary care settings are lacking.
We estimated consumption and costs of oral amoxicillin and amoxicillin plus clavulanic acid (co-amoxiclav) for young children and identified variations in the relative distribution of consumption and costs across countries and income groups. 2015 IQVIA-MIDAS antibiotic wholesale data for 75 low-, lower-middle-, upper-middle- and high-income countries/regions were used to determine sales volume of all child-appropriate formulations (CAF). Value was estimated by applying 2015 median global buyer prices from the International Medical Products Price Guide. Cost and consumption estimates for each World Bank income group were applied to the size of the pediatric population not represented in IQVIA to estimate total global consumption and costs. We modelled potential cost savings under different plausible scenarios of the distribution of consumption of the two antibiotics.
CAFs of amoxicillin and co-amoxiclav had estimated global sales values of 171 million and 540 million USD in 2015, respectively. Co-amoxiclav accounted for 45.8% of consumption and 75.5% of sales value. Co-amoxiclav consumption ranged from 3.3% (Norway) to 99.7% (Kuwait) of the two antibiotics. The median consumption was 11.6 standard units (SUs) of amoxicillin (IQR 3.5- 20.5) and 8.2 SUs of co-amoxiclav per child-year (IQR: 3.2, 16.0). 71 million USD (10% reduction) could be saved if all amoxicillin consumption was in solid rather than liquid formulations. Targeting co-amoxiclav use to a maximum of 10% of combined use of the two antibiotics would save approximately 219 million USD (38% reduction). Co-amoxiclav use is very common in some countries and accounts for a disproportionate fraction of cost, relative to consumption. Estimates represent wholesale purchases specifically and are only a fraction of total cost and consumption. Large efficiency gains seem feasible by encouraging amoxicillin for treating non-severe infections and limiting co-amoxiclav use to target severe infections.
The results were disseminated in an e-poster and discussed as part of an oral summary session of e-posters focused on antibiotic stewardship in pediatrics at ECCMID 2021.