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. 2020 Oct 20;15(10):e0240830.
doi: 10.1371/journal.pone.0240830. eCollection 2020.

Purchase and use of antimicrobials in the hospital sector of Vietnam, a lower middle-income country with an emerging pharmaceuticals market

Vu Quoc Dat  1   2   3 , Phan Khanh Toan  1 , H Rogier van Doorn  3   4 , C Louise Thwaites  3   4 , Behzad Nadjm  3   5
Affiliations

Purchase and use of antimicrobials in the hospital sector of Vietnam, a lower middle-income country with an emerging pharmaceuticals market

Vu Quoc Dat et al. PLoS One. .

Abstract

Introduction: Antimicrobial use is associated with emergence of antimicrobial resistance. We report hospital antimicrobial procurement, as a surrogate for consumption in humans, expenditure and prices in public hospitals in Vietnam, a lower middle-income country with a high burden of drug resistant infections.

Method: Data on antimicrobial procurement were obtained from tender-winning bids from provincial health authorities and public hospitals with detailed bids representing 28.7% (1.68 / 5.85 billion US $) of total hospital medication spend in Vietnam. Antimicrobials were classified using the Anatomical Therapeutic Chemical (ATC) Index and the 2019 WHO Access, Watch, Reserve (AWaRe) groups. Volume was measured in number of Defined Daily Doses (DDD). Antimicrobial prices were presented per DDD.

Results: Expenditure on systemic antibacterials and antifungals accounted for 28.6% (US $482.6 million/US $1.68 billion) of the total drug bids. 83% of antibacterials (572,698,014 DDDs) by volume (accounting for 45.5% of the antibacterials spend) were domestically supplied. Overall, the most procured antibacterials by DDD were second generation cephalosporins, combinations of penicillins and beta-lactamase inhibitors, and penicillins with extended spectrum. For parenteral antibacterials this was third generation cephalosporins. The average price for antibacterials was US $15.6, US $0.86, US $0.4 and US $11.7 per DDD for Reserve, Watch, Access and non-recommended/unclassified group antibacterials, respectively.

Conclusions: Antimicrobials accounted for a substantial proportion of the funds spent for medication in public hospitals in Vietnam. The pattern of antibacterial consumption was similar to other countries. The high prices of Reserve group and non-recommended/unclassified antibacterials suggests a need for a combination of national pricing and antimicrobial stewardship policies to ensure appropriate accessibility.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Proportional antibacterial procurement in DDD (%) by AWaRe classification.
Fig 2
Fig 2. The proportion of bidding price and number of DDD of antimicrobials for systemic antibacterial (J01) by route of administration in hospitals in Vietnam.
Fig 3
Fig 3. ABC analysis of the quantities of procured antibacterials (in DDD) and the price.
Fig 4
Fig 4. Number of antimicrobial manufacturers in Vietnam.
See this image and copyright information in PMC

References

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