The cost of antibiotic treatment for priority infectious syndromes in Paraguay, 2004 Eugenio Baez, Social Security Institute of Paraguay; María Auxiliadora Dentice, Ministry of Health of Paraguay; Ingrid Heitmann, Public Health Institute of Chile.
Antibiotics are essential for the treatment of human infections. In order to respond to the demand, the pharmaceutical industry in Paraguay provides the public with a large variety of commercial brands, both nationally-produced as well as imported. In the private health care sector, the public purchases prepackage antibiotics from pharmacies. Each package may have the exact number of tablets or capsules necessary to complete the treatment regimen indicated. On occasions, there is a remainder of unused tablets that should be discarded to prevent future use without adequate medical supervision. The unused, discarded portion is an economic waste. In public institutions, such as the Social Security Institute (SSI), these products are acquired through a bidding process and the patient is given only the necessary units to complete the treatment regimen in accordance with the medical advice.
Taking into account the importance and economic variability of different antibiotic treatments for common infectious diseases in adult patients in Paraguay and the influence of therapeutic failure for these costs, it is of interest to determine the cost of those interventions for which the Ministry of Health in Paraguay has promoted standard antibiotic treatment protocols. The costs of antibiotics emphasize the differences among them, depending on the brand, the source (national or imported), and whether acquired in the public or private sector.
The syndromes for which the cost of treatment was determined were selected from those that occur more frequently among adult ambulatory patients. The standard protocol (antibiotic, dose, route, interval, and duration) was described in the “Guide for the Treatment of Infectious Diseases” (PAHO).1 The cost of the drugs is based on the cost of the package or packages necessary to accomplish the treatment regimen for these specific syndromes. The cost of the unused units was determined by multiplying the cost of each unit in the package by the number of units remaining. In the SSI, the cost refers to the total number of units of the product that are necessary to complete the regimen indicated by the physician. The results, expressed in United States dollars (5,000 Guaranies = US$1) are shown in Table 1.
Twentyfour drugs were analyzed, some of them in different presentations. It was determined that three were exclusively imports. Similarly, two of the antibiotics of choice are only produced abroad and seven are only produced locally.
The results show that there is a difference in the cost to the public for treating the different syndromes depending on the source of the product (the nationally produced drugs are cheaper), and the brand name; this variation can be as high as 300% for some drugs. The use of alternative treatments represents an additional cost, many times higher than that of first choice drugs. Similarly, it should be noted that the cost for unused units ranges from US$0.40 to US$48.00 depending on the product. If one considers that the syndromes and diseases included in the analysis occur most frequently among adults and they represent a significant fraction of hospital diagnoses, the economic impact could be significant. This waste of units, whose cost is absorbed by the patient, could justify the commercial production of some drugs for the therapeutic regimen for some specific diseases in order to prevent financial loss to the public.
The purchase of medicines through the official (SSI) bidding process represents considerable savings. The savings could be even higher if the treatment is dispensed in the exact dosage. This is not only in the pharmacy, but also in the SSI, where the cost of the drug of choice for the treatment regimen is lower when compared to the alternative treatment. The savings are even greater when there is no treatment failure that justifies the use of more expensive drugs of the second line or last generation.
These findings show the theoretical savings saving of using standard treatment guidelines. In addition, considering that the major part of ambulatory treatment is empirical and that the use of treatment protocols requires knowledge of the prevalence of the causal pathogens, this work also justifies the implementation of a local surveillance system for resistant strain of antimicrobials.
References:
1. Organización Panamerica de la Salud, Guía para el Tratamiento de las Enfermedades Infecciosas. OPS/DPC/CD/296/2004.
Acknowledgment:
This study was made possible through support provided by the Office of Regional Sustainable Development, Bureau for Latin America and the Caribbean, U.S. Agency for International Development, under the terms of Grant No. LAC-G-00-00002-00.
Note:
The opinions expressed in this report are those of the authors and do not necessarily reflect the views of the U.S. Agency for International Development.
