OBJECTIVES: China is the largest antibiotics consumer in the world. The government has launched a series of strategies to reduce medical cost in hospitals, such as expending zero mark-up policy to hospitals in 2017. This study aims to evaluate the trends of antibiotics procurement cost in public healthcare institutions through analyzing the provincial centralized bidding procurement (CBP) data in Shandong Province, China.

METHODS: The Shandong CBP system covered 500 secondary and tertiary hospitals, 600 urban primary healthcare centres (PHCs) and 1600 rural PHCs. All the antibiotics procurement records were collected from the CBP system between 2012 and 2017. The cost was measured by using average annual procurement cost for antibiotics, which was calculated as total antibiotics procurement cost/total inhabitants. The number of inhabitants we used was based on the year-end population.

RESULTS: The average annual procurement cost for all antibiotics increased from 31.9 RMB in 2012 to 48.3 RMB in 2016, then decreased to 26.5 RMB in 2017. Penicillins was the class spent the most. In 2017, each person spent 0.16 RMB for the last resort antibiotics-carbapenem in Shandong. From 2012 to 2016, both the cost for oral and parenteral antibiotics increased by half, while they reduced 25% and 47% , respectively, from 2016 to 2017. More than 70% of the total antibiotics procurement cost was spent in the secondary and tertiary hospitals. The cost has decreased since 2016 in secondary and tertiary hospitals and urban PHCs, while it has declined since 2014 in rural PHCs. The antibiotics Shandong spent the most were Cefazolin Sodium for injection, followed by Amoxicillin and Azithromycin.

CONCLUSIONS: The zero-markup policy may be associated with the reduction on antibiotics procurement cost in public healthcare institutions. Secondary and territory hospitals are the key institutions to control antibiotics cost. Efforts should be made to improve rational antibiotics use.