Global estimates of the relative pediatric consumption and cost of oral amoxicillin and amoxicillin plus clavulanic acid
Authors: G. A. Levine, M. Sharland, S. Ellis, Y. Ferrisse, C. Loze, Y. Hsia, G. Fink, J. Bielicki; for the PediCAP project
Published in: ECCMID 2021
Background: Amoxicillin and co-amoxiclav are commonly used antibiotics for community-acquired infections in young children. Both are classified as Access antibiotics for pediatric respiratory infections in the WHO EMLc. Despite higher cost, robust data to support the additional clinical benefit of co-amoxiclav in primary care settings are lacking. Relative consumption and their economic implications globally are unknown.
Materials/Methods: We estimated consumption and costs of oral amoxicillin and co-amoxiclav for young children and identified variations across countries. 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. We estimated value and consumption in standard units (SU) (single tablet/capsule solid or 5 mL liquid preparation) per child-year for each country using United Nations Population data annual population estimates. 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 cost savings compared with 2015 observed estimates under different plausible scenarios.
Results: 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 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 would save approximately 219 million USD (38% reduction).
Conclusions: 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.