ANTIBIOTIC EXPENDITURE AMONG HOSPITALIZED PATIENTS USING THE WORLD HEALTH ORGANIZATION AWARE CLASSIFICATION IN TUNISIA
Author(s)
leila Achour, MSc1, Samiha Toumi, PharmD2, IKRAM FAZAA, PharmD1, Yosr Trabelsi, PharmD3, Hend Chaker, PharmD4, CHEMA DRIRA, MASc, MSc, PharmD1, Myriam Khrouf, PharmD3, Hajer Felfel, PharmD3.
1University of Tunis Manar, LR18ES39, Tunis, Tunisia, 2Agence Nationale des medicaments et produits de santé, Tunis, Tunisia, Tunis, Tunisia, 3university of pharmacy of monastir, Tunis, Tunisia, 4Genomics and oncogenetics research laboratory, Institute Pasteur of Tunis, Tunis, Tunisia, Tunis, Tunisia.
1University of Tunis Manar, LR18ES39, Tunis, Tunisia, 2Agence Nationale des medicaments et produits de santé, Tunis, Tunisia, Tunis, Tunisia, 3university of pharmacy of monastir, Tunis, Tunisia, 4Genomics and oncogenetics research laboratory, Institute Pasteur of Tunis, Tunis, Tunisia, Tunis, Tunisia.
OBJECTIVES: To evaluate antibiotic consumption in the Tunisian public sector in 2023, focusing on utilization patterns, AWaRe distribution, and associated costs across levels of care.
METHODS: A nationwide pharmacoeconomic analysis was conducted using aggregated data from public healthcare facilities. Antibiotic use was expressed as defined daily doses per 1,000 inhabitants per day (DDD/1,000 inhabitants/day), according to World Health Organization methodology. Antibiotics were categorized using the AWaRe classification. Costs were converted to euros (€) and analyzed by line of care and route of administration.
RESULTS: Total public-sector antibiotic consumption reached 2.79 DDD/1,000 inhabitants/day, corresponding and an expenditure of €9.7 million. Third-line hospitals accounted for 48% of volume but 61% of total expenditure (€5.9 million), reflecting the use of high-cost injectable antibiotics (cost/DDD €3.68). In contrast, first-line care represented 19% of volume and 12% of costs (€1.1 million), driven by low-cost oral Access antibiotics (cost/DDD €0.13). Parenteral administration dominated (79% of volume; 87% of expenditure), particularly in second- and third-line settings. AWaRe analysis showed a predominance of Access antibiotics in first-line care (95% of DDD), whereas Watch and Reserve antibiotics accounted for a larger share in higher-level facilities, contributing substantially to costs. High-cost agents such as carbapenems, colistin, and fosfomycin accounted for a disproportionate share of expenditure despite low DDD contribution.
CONCLUSIONS: Antibiotic use in the Tunisian public sector reflects appropriate reliance on Access antibiotics in primary care, but a cost-intensive pattern in hospital settings driven by Watch and Reserve agents. Strengthening antimicrobial stewardship, particularly targeting high-cost injectable antibiotics in tertiary care, is essential to optimize resource use and mitigate antimicrobial resistance
METHODS: A nationwide pharmacoeconomic analysis was conducted using aggregated data from public healthcare facilities. Antibiotic use was expressed as defined daily doses per 1,000 inhabitants per day (DDD/1,000 inhabitants/day), according to World Health Organization methodology. Antibiotics were categorized using the AWaRe classification. Costs were converted to euros (€) and analyzed by line of care and route of administration.
RESULTS: Total public-sector antibiotic consumption reached 2.79 DDD/1,000 inhabitants/day, corresponding and an expenditure of €9.7 million. Third-line hospitals accounted for 48% of volume but 61% of total expenditure (€5.9 million), reflecting the use of high-cost injectable antibiotics (cost/DDD €3.68). In contrast, first-line care represented 19% of volume and 12% of costs (€1.1 million), driven by low-cost oral Access antibiotics (cost/DDD €0.13). Parenteral administration dominated (79% of volume; 87% of expenditure), particularly in second- and third-line settings. AWaRe analysis showed a predominance of Access antibiotics in first-line care (95% of DDD), whereas Watch and Reserve antibiotics accounted for a larger share in higher-level facilities, contributing substantially to costs. High-cost agents such as carbapenems, colistin, and fosfomycin accounted for a disproportionate share of expenditure despite low DDD contribution.
CONCLUSIONS: Antibiotic use in the Tunisian public sector reflects appropriate reliance on Access antibiotics in primary care, but a cost-intensive pattern in hospital settings driven by Watch and Reserve agents. Strengthening antimicrobial stewardship, particularly targeting high-cost injectable antibiotics in tertiary care, is essential to optimize resource use and mitigate antimicrobial resistance
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE491
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Infectious Disease (non-vaccine)