ANTIBIOTIC USE AND EXPENDITURE IN TUNISIA: INSIGHTS FROM THE WHO AWARE CLASSIFICATION
Author(s)
Samiha Toumi, PharmD1, Mabahej Mefteh, PharmD2, IKRAM FAZAA, PharmD3, Ines Fradi, PharmD2, Hend Chaker, PharmD4, Myriam Khrouf, PharmD2, CHEMA DRIRA, MSc3, Hajer Felfel, MSc2, leila Achour, MSc3.
1Agence Nationale des medicaments et produits de santé, Tunis, Tunisia, TUNIS, Tunisia, 2university of pharmacy of monastir, Monastir, Tunisia, 3University of Tunis Manar, LR18ES39, Tunis, Tunisia, 4Genomics and oncogenetics research laboratory, Institute Pasteur of Tunis, Tunis, Tunisia, Tunis, Tunisia.
1Agence Nationale des medicaments et produits de santé, Tunis, Tunisia, TUNIS, Tunisia, 2university of pharmacy of monastir, Monastir, Tunisia, 3University of Tunis Manar, LR18ES39, Tunis, Tunisia, 4Genomics and oncogenetics research laboratory, Institute Pasteur of Tunis, Tunis, Tunisia, Tunis, Tunisia.
OBJECTIVES: To assess antibiotic consumption in Tunisia in 2023 using the AWaRe (Access, Watch, Reserve) classification, with a focus on utilization patterns and associated costs.
METHODS: A nationwide pharmacoeconomic analysis was conducted using aggregated antibiotic consumption data from public and private sectors. Antibiotics were categorized according to the AWaRe classification. Expenditures were converted to euros (€) and analyzed alongside cost per DDD. Subgroup analyses were performed by manufacturing origin (local vs imported) and product type (generic vs originator).
RESULTS: Total antibiotic consumption reached 31.8 DDD/1,000 inhabitants/day, corresponding to an expenditure of €95.8 million which represent 12.5% of total medicines expenditure in Tunisia in 2023. Access antibiotics accounted for 63% of volume and 74% of DDD, with a low cost per DDD (€0.52). Watch antibiotics represented 37% of volume and 24% of DDD, with a higher cost per DDD (€1.07). Reserve antibiotics were minimally used (0.1% of volume; 0.06% of DDD) but accounted for 3% of total expenditure due to a high cost per DDD (€40.1).Locally manufactured antibiotics represented 97% of total consumption (30.9 DDD/1,000 inhabitants/day), mainly from the Access group and at lower cost. Imported antibiotics were primarily Watch and Reserve agents, less frequently used but more expensive. Generics accounted for 66% of volume and 63% of expenditure, with a lower cost per DDD than originators (€0.64 vs €0.75).
CONCLUSIONS: The cost and utilization of Watch and Reserve antibiotics highlight the need for strengthened stewardship and cost-containment strategies.
METHODS: A nationwide pharmacoeconomic analysis was conducted using aggregated antibiotic consumption data from public and private sectors. Antibiotics were categorized according to the AWaRe classification. Expenditures were converted to euros (€) and analyzed alongside cost per DDD. Subgroup analyses were performed by manufacturing origin (local vs imported) and product type (generic vs originator).
RESULTS: Total antibiotic consumption reached 31.8 DDD/1,000 inhabitants/day, corresponding to an expenditure of €95.8 million which represent 12.5% of total medicines expenditure in Tunisia in 2023. Access antibiotics accounted for 63% of volume and 74% of DDD, with a low cost per DDD (€0.52). Watch antibiotics represented 37% of volume and 24% of DDD, with a higher cost per DDD (€1.07). Reserve antibiotics were minimally used (0.1% of volume; 0.06% of DDD) but accounted for 3% of total expenditure due to a high cost per DDD (€40.1).Locally manufactured antibiotics represented 97% of total consumption (30.9 DDD/1,000 inhabitants/day), mainly from the Access group and at lower cost. Imported antibiotics were primarily Watch and Reserve agents, less frequently used but more expensive. Generics accounted for 66% of volume and 63% of expenditure, with a lower cost per DDD than originators (€0.64 vs €0.75).
CONCLUSIONS: The cost and utilization of Watch and Reserve antibiotics highlight the need for strengthened stewardship and cost-containment strategies.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE341
Topic
Economic Evaluation, Epidemiology & Public Health
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Infectious Disease (non-vaccine)