Temporal decrease in overall antibiotic consumption accompanying antibiotic prescribing rate disclosure policy: Evidence from analysis of national health insurance claims data in South Korea

The health insurance review and assessment services, responsible for the assessment of quality and quantity of healthcare providers' services, implemented a public disclosure policy for antibiotic prescribing rate in February 2006. The aim of this study was to investigate changes of overall antibiotic consumption following the policy by analysing national healthcare utilization data from 2005 to 2009. Prescription information of systemic antibiotics excluding antifungals and topical antibiotics was retrospectively collected from the population-based health insurance claims sample data for the five years from 2005 to 2009. Those data were analysed using the standardised anatomical therapeutic chemical/defined daily dose method. Antibiotic consumption was standardised by the defined daily dose per 1,000 inhabitants per day (DID). Descriptive statistics was used to present consumption figures for every year. Secondary comparison to other OECD countries based on published reports was added to weigh the antibiotic consumption level of South Korea in a global perspective. Overall antibiotic consumption decreased in 2006 (23.8 DID, 3.6 % decrease from 24.7 DID in 2005) and 2007 (21.5 DID, 9.7 % decrease from 2006), but rebounded in 2008 (24.3 DID, 13 % increase from 2007) and 2009 (25.2 DID, 3.7 % increase from 2008). Temporal decreases in 2006 and 2007 were attributed to fewer prescriptions of penicillins (J01C group), among which the decrease in amoxicillin consumption was almost equal to that of overall antibiotic consumption. A similar fluctuation trend in overall antibiotic consumption occurred in the out-patient setting rather than the in-patient setting. Amoxicillin decreased since 2007, while amoxicillin/clavulanic acid, cefaclor and clarithromycin increased without dropping. The estimated antibiotic consumption level in this study was higher than the average of OECD countries, and the yearly fluctuation shown during the five years was a country specific pattern observed only in South Korea. Overall antibiotic consumption was temporarily decreased in 2006 and 2007. But this result might not signify an effect of government policy of antibiotic prescribing rate disclosure to the public. The results presented in DID unit, a more objective index than prescribing rates, suggest the need for further strategies to reduce antibiotic use nationwide.