Disentangling spillover effects of antibiotic consumption: a spatial panel approach

Literature on socioeconomic determinants of antibiotic consumption in the community is limited to few countries using cross-sectional data. This article analyses regional variations in outpatient antibiotics in Italy using a balanced panel dataset covering the period 2000 to 2008. We specify an econometric model in which antibiotic consumption depends upon demographic and socioeconomic characteristics of the population, the supply of health care services in the community, and antibiotic copayments. The model is estimated by means of Ordinary Least Squares (OLS) techniques with Fixed Effects (FE). The implications of consumption externalities across geographical areas are investigated by means of Spatial-Lag and Spatial-Error models (SLFE and SEFE). We find significant and positive income elasticity and negative effects of copayments. Antibiotic use is also affected by the age structure of the population and the supply of community health care. Finally, we find evidence of spatial dependency in the use of antibiotics across regions. This suggests that regional policies (e.g. public campaigns) aimed at increasing efficiency in antibiotic consumption and controlling bacterial resistance may be influenced by policy makers in neighbouring regions. There will be scope for a strategic and coordinated view of regional policies towards the use of antibiotics.