Doctoral thesis

Essays on outpatient antibiotic consumption


76 p

Thèse de doctorat: Università della Svizzera italiana, 2011 (jury note: magna cum laude)

English Inappropriate use of antibiotic leads to the development of bacterial resistance, which undermines antibiotic effectiveness and increases the cost for society. The aim of this thesis is to investigate economic aspects of antibiotic consumption in the community. The research is divided in three essays. In the first essay we focus on determinants of antibiotic use in Italy and the spillover effects of antibiotic consumption across regions. We specify and estimate an econometric model by means of ordinary least squares techniques with fixed (FE) and random effects (RE). The implications of consumption spillovers across geographical areas are investigated by using spatial-lag and spatial-error models (SLFE and SEFE). The results suggest that regional policies aimed at increasing efficiency in antibiotic consumption and controlling bacterial resistance may be influenced by policy makers in neighbouring regions. In the second essay we assume that antibiotics are similar to addictive goods, since current consumption is reinforced by past use because of bacterial resistance. The goal of the second essay is to explore how consumers adjust their current level of antibiotic consumption towards desired levels over time. We apply alternative dynamic estimators for short panels: the bias-corrected least squares dummy variable (LSDVC) and the System Blundell-Bond GMM estimator (GMM-BB). The results show that antibiotic use in previous periods has a positive impact on current antimicrobial consumption. Finally, the third essay investigates the impact of national policies towards a rational consumption of antibiotics. We use comparable data on systemic administered antibiotics and socioeconomic determinants in 21 European countries for a 11-years panel. Using a difference-in-differences approach, we estimate an econometric model with fixed effects. Lagged values and instrumental variables approach are applied to address endogeneity aspects of the prevalence of infections and the adoption of national campaigns. We found that public campaigns significantly reduce the use of antimicrobials in the community in all the estimations.
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