Is het chinolonengebruik in België gedaald door de gewijzigde terugbetalingsvoorwaarden van 2018?

Abstract

Has the use of quinolones in Belgium decreased due to the introduction of reimbursement conditions in 2018? The substantial adverse drug reactions and contribution to antimicrobial resistance of quinolones implore public health initiatives to restrict the usage of these antibiotics. One such initiative in Belgium was to only reimburse quinolones under stringent conditions from May 2018 onwards. In this article, the authors aim to assess the effectiveness of this policy by charting the evolution of quinolone use. This study is based on reimbursement data of quinolones delivered to members of the Christian health insurance fund (CM) in public pharmacies from May 1, 2016 to April 30, 2021. The variables of interest are the number of users and the volume in defined daily dose (DDD). Diagnostic data about members with approval for reimbursement were obtained from the database of the CM, containing authorisations of reimbursement. 19% to 28% of the authorisations were justified as ‘exceptional’ situations without any specific diagnosis. The number of users of reimbursed quinolones decreased by 75% immediately after the implementation of the policy, although a decrease of only 36% was observed in the overall use of quinolones (reconstructed by means of statistics provided by the Belgian society of public pharmacists (APB)). The reimbursement policy in 2018 induced a substantial decrease (75%) in the use of reimbursed quinolones, but also a considerable increase in the use of non-reimbursed quinolones. Although the overall use still has decreased remarkably (36%) since the policy, the decrease was insufficient to reduce the use of quinolones to the objective of 5% of all prescribed antibiotics. In order to keep the quinolone use within reasonable bounds, the authors encourage education of health practitioners, dialogue between medical actors and sensibilisation of users. In addition, this study draws attention to the need for publicly available data on both reimbursed and non-reimbursed medication.