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Resistance-induced antibiotic substitution

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  • David H. Howard

    (Department of Health Policy and Management, Rollins School of Public Health, Emory University, USA)

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    Abstract

    In many cases, physicians prescribe antibiotics without knowing whether an individual patient is infected with a susceptible or resistant pathogen. As the proportion of resistant organisms in a community increases, physicians substitute away from older-inexpensive drugs to newer, more expensive agents as first line therapy. This paper explores the implications of resistance-induced antibiotic substitution for epidemiological models to predict future resistance levels, efforts to measure the health care costs associated with resistance, and policies to improve physicians' antibiotic prescribing decisions. The extent of resistance-induced substitution in outpatient settings is documented using a data set consisting of observations on initial physician office visits for otitis media in the US controlling for new product introductions and price increases, per prescription antibiotic spending increased by 22% between 1980 and 1996, corresponding to a steep increase in resistance levels over the same period. Copyright © 2004 John Wiley & Sons, Ltd.

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    File URL: http://hdl.handle.net/10.1002/hec.856
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    Bibliographic Info

    Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

    Volume (Year): 13 (2004)
    Issue (Month): 6 ()
    Pages: 585-595

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    Handle: RePEc:wly:hlthec:v:13:y:2004:i:6:p:585-595

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    Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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    1. Laxminarayan, Ramanan & Brown, Gardner M., 2001. "Economics of Antibiotic Resistance: A Theory of Optimal Use," Journal of Environmental Economics and Management, Elsevier, vol. 42(2), pages 183-206, September.
    2. Brown, Gardner & Layton, David F., 1996. "Resistance economics: social cost and the evolution of antibiotic resistance," Environment and Development Economics, Cambridge University Press, vol. 1(03), pages 349-355, July.
    3. Elamin H. Elbasha, 2003. "Deadweight loss of bacterial resistance due to overtreatment," Health Economics, John Wiley & Sons, Ltd., vol. 12(2), pages 125-138.
    4. Catherine A. Goodman & Paul G. Coleman & Anne J. Mills, 2001. "Changing the first line drug for malaria treatment-cost-effectiveness analysis with highly uncertain inter-temporal trade-offs," Health Economics, John Wiley & Sons, Ltd., vol. 10(8), pages 731-749.
    5. Joanna Coast & Richard Smith & Anne-Marie Karcher & Paula Wilton & Michael Millar, 2002. "Superbugs II: how should economic evaluation be conducted for interventions which aim to contain antimicrobial resistance?," Health Economics, John Wiley & Sons, Ltd., vol. 11(7), pages 637-647.
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    Cited by:
    1. Richard D. Smith & Milton Yago & Michael Millar & Joanna Coast, 2006. "A Macroeconomic Approach to Evaluating Policies to Contain Antimicrobial Resistance: A Case Study of Methicillin-Resistant Staphylococcus aureus (MRSA)," Applied Health Economics and Health Policy, Springer Healthcare | Adis, vol. 5(1), pages 55-65.
    2. Amit Batabyal & Peter Nijkamp, 2005. "Alternate Strategies for Managing Resistance to Antibiotics and Pesticides," ERSA conference papers ersa05p161, European Regional Science Association.
    3. Filippini, M. & Masiero, G. & Moschetti, K., 2009. "Regional consumption of antibiotics: A demand system approach," Economic Modelling, Elsevier, vol. 26(6), pages 1389-1397, November.

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