title: Variation in outpatient antibiotic prescribing in the United States.
abstract: OBJECTIVE
  To evaluate variation in outpatient antibiotic utilization among US commercial health plans and the implications of this variation for cost and quality.
  
  
  METHODS
  We measured antibiotic utilization rates among 229 US commercial health plans that participated in the 2005 Healthcare Effectiveness Data and Information Set. Rates were adjusted to account for health plan age and sex distribution. To estimate antibiotic costs, we multiplied utilization data for each drug class by national estimates of intraclass distribution of drugs, duration of therapy, and median average wholesale price.
  
  
  RESULTS
  Antibiotic utilization rates varied markedly among plans, ranging from 0.64 antibiotic fills per member per year (PMPY) at the 5th percentile of plans to 1.08 fills PMPY at the 95th percentile, with a mean of 0.88 (SD +/- 0.15) antibiotic fills PMPY. US census region was the strongest predictor of antibiotic utilization. Antibiotic costs averaged $49 PMPY and ranged from $34 to $63 PMPY among plans at the 5th and 95th percentiles of cost, respectively. If a health plan with 250,000 members at the 90th percentile of antibiotic costs reduced its costs to the 25th percentile, annual drug cost savings would be approximately $4.1 million.
  
  
  CONCLUSIONS
  Antibiotic utilization varies substantially among commercial health plans and is not accounted for by differences in the age and sex distribution of plan members. Because reducing rates of antibiotic utilization is likely to lower costs and improve quality, high-utilizing plans may reap considerable rewards from investing in programs to reduce the overuse of antibiotics.
authors.affiliation: San Francisco VA Medical Ctr, 4150 Clement St, Box 181-G, San Francisco, CA 94121, USA. mike.steinman@ucsf.edu
authors.forename: Michael A
authors.initials: MA
authors.lastname: Steinman
authors.forename: Katherine Y
authors.initials: KY
authors.lastname: Yang
authors.forename: Sepheen C
authors.initials: SC
authors.lastname: Byron
authors.forename: Judith H
authors.initials: JH
authors.lastname: Maselli
authors.forename: Ralph
authors.initials: R
authors.lastname: Gonzales
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000145:classification / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents