In 2013, a change in copayment rate was introduced in the Basque Country (one year later than in the other regions in Spain), and improvements were made to drug packaging. In 2014, a National Program Against Bacterial Resistance (Spanish abbreviation: PRAN) was approved. The aim of this study is to analyze the impact of change to the copayment rate, the adjustment of drug packaging, and the approval of PRAN on the consumption of antibiotics. Raw monthly data on the consumption of antibiotics (costs, packages, and daily defined doses per thousand people (DID)) were collected from January 2009 to December 2018 in the Basque Country. Counterfactual and intervention analysis (Autoregressive integrated moving average (ARIMA) model) was performed for the total series, disaggregated by group of antibiotics (2019 WHO Access, Watch, and Reserve (AWaRe) Classification) and active substances with the highest cost per prescription (cefditoren and moxifloxacin), the lowest cost per prescription (doxycycline and cloxacillin), and the most prescribed active ingredients (amoxicillin, azithromycin, and levofloxacin). Introduction of copayment led to a ‘stockpiling effect’ one month before its implementation, equal to 8% in the three consumption series analyzed. Only the adjustment of drug packaging significantly reduced the number of packages dispensed (−12.19%). PRAN approval reduced consumption by 0.779 DID (−4.51%), representing a significant decrease for both ’access’ and ’watch’ group antibiotics. Despite the delay in implementing changes to copayment, there was a ‘stockpiling effect’. With the adjustment of packaging, fewer packs were prescribed but with a higher drug load and price. PRAN approval reduced both the consumption of ’access group antibiotics’ (first-line treatment) and ’watch group antibiotics’ (second-line treatment).

中文翻译：

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减少抗生素消费的政策：对巴斯克地区的影响。

2013年，巴斯克地区引入了自付费用率的变化（比西班牙其他地区晚一年），药物包装得到了改善。2014年，批准了一项国家抗细菌耐药性计划（西班牙语缩写：PRAN）。这项研究的目的是分析改变共付额率，调整药物包装以及批准PRAN对抗生素消费的影响。从2009年1月至2018年12月在巴斯克地区收集有关抗生素消费的每月原始数据（成本，包装和每千人每日确定剂量（DID））。对整个系列进行了事实调查和干预分析（自回归综合移动平均值（ARIMA）模型），并按抗生素组进行了分类（2019 WHO Access，Watch，和储备（AWaRe）分类），以及每处方​​费用最高的活性物质（头孢妥仑和莫西沙星），每处方费用最低的活性物质（强力霉素和氯氧西林），以及处方最多的活性成分（阿莫西林，阿奇霉素和左氧氟沙星）。共付制的引入在实施前一个月就产生了“库存效应”，相当于所分析的三个消费系列的8％。只有调整药物包装才能显着减少分配的包装数量（-12.19％）。PRAN批准使消费量减少了0.779 DID（-4.51％），这意味着“获取”和“观察”组抗生素均大幅减少。尽管延迟实施共付额更改，但仍存在“库存效应”。随着包装的调整，处方的药盒数量减少了，但药物的用量和价格却更高。PRAN批准减少了“进入组抗生素”（一线治疗）和“观察组抗生素”（二线治疗）的消耗。