The Hidden Costs of Antibiotic Misuse

By: Janet Young, MD

July 15, 2021

Have you ever asked your physician for an antibiotic for a cold or other viral infection, just in case it might help? After all, a typical antibiotic prescription only costs a few dollars and seems harmless. And if you’ve received them for a viral infection, you’re not alone. The CDC estimates that 1 out of every 3 outpatient antibiotic prescriptions are unnecessary1.

However, this care pattern is one of many that are considered to represent “low value care.” Low value care includes services that provide little benefit and have the potential for harm. They are often clinically nuanced, meaning that a service may be appropriate for some individuals based on factors like comorbid conditions and age, but represent low value care for others. For instance, antibiotics are appropriate for treatment of bacterial pneumonia but are considered low value care when prescribed for the common cold.


Added Costs and Harm are Risks

Something often overlooked when considering low value care services, like prescribing antibiotics for viral infections, is that the cost of the service itself may be only a portion of the resulting overall healthcare cost impact. In addition to the initial cost from a service that provides little or no benefit to patients, these services have the potential to cause harm and can result in the need for services that result in additional costs.

These additional costs may be related to complications from the service itself, like allergic reactions or side effects due to antibiotics. Other low value services, like unnecessary imaging tests, may result in a cascade of costly diagnostic tests and unnecessary procedures for incidental findings.


Potential Adverse Effects of Antibiotics and Related Costs

To understand the impact of unnecessary antibiotic prescriptions on costs, you need to factor in potential complications from taking antibiotics. Antibiotics commonly cause side effects, like nausea, diarrhea, or skin rashes, leading to expensive emergency room visits, office visits, and potential loss of productivity or absenteeism. For example, did you know antibiotics are responsible for more ER visits for adverse drug effects than any other drug class in those under 502?

However, it’s important to keep in mind, even more serious side effects can occur. Antibiotics can kill some of the healthy bacteria that live in the intestines, opening the door to overgrowth of bad actors like Clostridium difficile (C. diff), which may result in hospitalization due to severe diarrhea, dehydration, sepsis, and other complications. C. diff., a costly and life-threatening infection, resulted in related healthcare costs of $1 billion and almost 13,000 deaths in the United States in 2017.3


Antibiotic-Related Costs, Springbuk 2020

But perhaps the biggest threat of misuse of antibiotics is the increasing number of infections caused by antibiotic-resistant organisms – bacteria and fungi that are no longer susceptible to antibiotics used to treat them in the past. When antibiotics are administered, susceptible bacteria are killed, leaving those that have a way to evade the antibiotic a chance to multiply, accelerating the development of antibiotic resistant strains. There are more than 2.8 million antibiotic-resistant infections in the U.S. each year, leading to 35,000 deaths, with predictions for higher rates in the future.4,5


Why are antibiotics prescribed for viral conditions?

Patients may request antibiotics for viral infections due to lack of understanding of the appropriate use of antibiotics or based on anecdotal “evidence” of its efficacy in prior illnesses that would have resolved without antibiotics. Physicians sometimes prescribe antibiotics for viral conditions due to concerns about patient satisfaction or lack of adequate time to explain why an antibiotic isn’t appropriate.6,7


Actions Employers Can Take

Educating employees and their families about appropriate use of antibiotics can diminish antibiotic use by reducing patient requests and ultimately impacting physician beliefs on patient satisfaction. Information campaigns could include posters, emails, mailings, and education during visits to on-site clinics to convey:

  • Antibiotics do NOT work for viral illnesses

  • Common conditions that can and cannot be treated with antibiotics

  • Potential harms from taking unnecessary antibiotics

  • Simple questions to ask, like “Could my symptoms improve without antibiotics? What else could I use for my symptoms?”

The CDC maintains easy-to-read educational materials on antibiotic use, including a checklist of when antibiotics should not be used, potential harms of antibiotics, and other topics, and most are available in multiple languages.


Key Takeaways

Since the discovery of penicillin almost 100 years ago, antibiotics have played an important role in treating bacterial infections. But, when used to treat viral infections, they have led to unnecessary harm and costs. Educating members about appropriate antibiotic use is a step in reducing unnecessary antibiotic use.

Springbuk has released new Low Value Care Insights™ cards within the health data analytics platform, providing information related to occurrences and potential strategies to reduce antibiotic misuse, unnecessary imaging procedures, and non-recommended screening exams.


References

1https://www.cdc.gov/media/releases/2016/p0503-unnecessary-prescriptions.html

2https://www.cdc.gov/medicationsafety/adverse-drug-events-specific-medicines.html

3https://www.cdc.gov/drugresistance/pdf/threats-report/clostridioides-difficile-508.pdf

4Antibiotic Resistance Threats in the United States 2019

5https://media.nature.com/original/magazine-assets/d41586-020-02884-3/d41586-020-02884-3.pdf

6Exploring Patient Awareness and Perceptions of the Appropriate Use of Antibiotics: A Mixed-Methods Study

7https://www.pewtrusts.org/en/research-and-analysis/articles/2017/06/30/why-doctors-prescribe-antibiotics-even-when-they-shouldnt

Janet Young, MD

With more than 20 years of experience, Janet Young has provided clinical expertise and oversight to the development of healthcare analytics used in provider, payer, employer, and government sectors. Most recently, Young served as a lead clinical scientist at IBM Watson Health, guiding clinical content development related to new models, methods and analytics using claims, EMR, Health Risk Assessment, and socio-demographic data.