Pediatric Antibiotic Costs 5 Times More in US Than in UK

Janis C. Kelly

December 26, 2013

A comparison of liquid antibiotic prescription usage and costs in 2009 found that children younger than 9 years enrolled in US private insurance plans were more likely to be treated with antibiotics, were more likely to receive azithromycin, and had to pay more for the same drugs compared with similar children treated under the UK's National Health Service plan, according to a study published online December 19 in Pharmacotherapy. The analysis did not include diagnosis or outcomes information.

Total estimated annual costs for liquid antibiotics for children younger than 9 years in 2009 were $2,525,000 for the US cohort vs $477,000 for the UK cohort.

"The annual cost was more than five times higher in the United States compared with the United Kingdom[.] The usage and cost of antibiotics in young privately insured children is far higher in the United States than in the United Kingdom, where the government pays the cost of prescription drugs," concluded the researchers, led by Hershel Jick, MD, director emeritus of the Collaborative Drug Surveillance Program and associate professor of medicine at Boston University School of Medicine in Massachusetts.

Dr. Jick's team compared 160,000 privately insured US children with 160,000 similar children treated in general practices in the United Kingdom. They found that antibiotics had been prescribed for 75% of the US children vs an estimated 50% of UK, children, that amoxicillin was prescribed for 43% of US children vs 34% of UK children, that azithromycin was prescribed for 26% of US children vs 3% of UK children, and that amoxicillin/clavulanate was prescribed for 19% of US children vs 3% of UK children. Treatment duration was 9 to 11 days in the United States, "except for azithromycin, which was regularly prescribed for only 5 days," vs 6 to 7 days in the United Kingdom.

Estimated annual drug cost per child for amoxicillin was $3.70 in the United States vs $4.05 in the United Kingdom. Annual cost for amoxicillin/clavulanate was $39.45 in the United States vs $6.81 in the United Kingdom. Annual cost for azithromycin was $21.30 in the United States but was not included in the reported cost for the United Kingdom.

"Although all of the antibiotics were available in generic formulation in both countries, the percentage of children prescribed an antibiotic was far higher in the United States. The particular antibiotics commonly prescribed in the United States were regularly more costly and regularly prescribed for longer durations," the authors write.

The authors also noted that the UK results applied to the entire population insured by a government universal health plan, but the US results applied only to those who enrolled with private health insurance companies. "This difference may itself introduce related subtle prescribing biases," the authors note.

Dr. Jick has disclosed no relevant financial relationships.

Pharmacotherapy. Published online December 19, 2013. Abstract


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