Injectable antibiotic use in India: public-private share in volume and cost

Consumption of injectable antibiotics is not widely studied, despite injectables constitute a major share of antibiotic cost. This study aimed to understand the share of oral and injectable antibiotic consumption and cost at the national level in India, and the public and private sector shares in the provision and cost of injectables in Kerala state.

We used the PharmaTrac private sector sales dataset and the Kerala Medical Services Corporation public sector procurement dataset. Using WHO Access, Watch, Reserve (AWaRe) and Anatomical Therapeutic Chemical (ATC) Classifications, we estimated the annual total and per-capita consumption, and the annual total, per defined daily dose (DDD), and per-capita spending on injectables.

Although 94.9% of total antibiotics consumed at the national level were oral preparations, 35.8% of total spending were on injectables. In Kerala , around 33% of total antibiotic spending in the private sector were for injectables, compared to around 25% in the public sector. The public sector used fewer injectable antibiotic formulations (n=21) compared the private sector (n=69). The cost per DDD was significantly higher in the private sector as compared to the public sector. Despite only accounting for 6.3% of the cost share, the public sector provided 31.4% of injectables, indicating very high efficiency. Across both sectors, Watch group antibiotics were significantly more consumed and at a significantly higher cost than Access group antibiotics, for example in nearly double the quantity and at 1.75 times the price per DDD in the private sector. Reserve group antibiotics made up the lowest consumption share (0.61% in the private sector), but at the highest cost per DDD (over 16 times that of Access).

Public sector showed higher cost efficiency in antibiotic provisioning compared to private sector. Appropriate antibiotic use cannot be achieved through drug price control alone but requires extensive engagement with private providers through structured stewardship programs.