Global Trends in Antibiotic Expenditure: Analysis of Pharmaceutical Sales Data, 2013 to 2023

BACKGROUND: Human antibiotic consumption is a major contributing factor to antimicrobial resistance. Understanding the dynamics of the antibiotic market can help improve antibiotic stewardship efforts and encourage innovation. METHODS: We used quarterly pharmaceutical sales value and volume data from IQVIA MIDAS to estimate aggregate and per capita real annual spending (inflation adjusted) on antibiotics in 62 countries from 2013 to 2023, with unit values defined by the ratio of sales value and quantity. We evaluated trends by broad classes of antibiotics and country income groups and conducted multivariate regression analyses to identify associations with factors such as income and health spending. RESULTS: Between 2013 and 2023, aggregate and per capita real spending on antibiotics decreased from $49.61 billion to $30.68 billion and from $12.08 to $7.92, respectively. Real spending per unit of antibiotic, which is an indicator of price but not necessarily the final consumer price, also declined from $0.85 (2013) to $0.45 (2023). Spending decreased across country income groups and converged, driven by more rapid reductions in high-income countries as compared with other regions. In 2020, spending decreased sharply due to the COVID-19 pandemic, followed by a small rebound. In multivariate analysis, income, health spending, median age, and clean water access were associated positively with spending on antibiotics per 1000 people, while schooling attainment, availability of doctors, and higher state capacity were associated negatively. CONCLUSIONS: Global spending on antibiotics declined and overall converged among countries from 2013 to 2023. More investment is necessary toward reducing antibiotic use and developing new effective antibiotics.