Peer-reviewed article
Long-Term Effectiveness of Financial Incentives for Not Prescribing Unnecessary Antibiotics to Children With Acute Respiratory and Gastrointestinal Infections: Japan's Nationwide Quasi-Experimental Study.
Okubo Y, Uda K, Miyairi I ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001A study in Japan examined whether paying healthcare providers money for explaining why they are not prescribing antibiotics to young children with common infections reduces unnecessary antibiotic use. The financial incentive of about $5.70 per case led to a 45% reduction in antibiotics prescribed immediately and a 19.5% reduction sustained over four years. Children who received this intervention did not end up in hospital more often or incur higher healthcare costs.
Key points
- Financial incentives of ¥800 (approximately $5.7) per case reduced antibiotic prescriptions by 44.9% in the first month
- The reduction in antibiotic prescriptions was sustained at 19.5% over 48 months
- Broad-spectrum antibiotic use decreased by 24.4% over the study period
- No increase in hospitalizations, after-hours visits, or overall healthcare costs was observed
- A dose-response relationship was found, with benefits leveling off after approximately 5 incentives per provider
Limitations
The study uses administrative data and focuses on a specific context (Japan) with particular healthcare and reimbursement systems, which may limit generalizability. The mechanism by which incentives worked (provider behavior change, communication with parents, or both) is not examined in detail.
Abstract
Background To address antibiotic overuse, the Japanese government implemented a novel financial incentive policy in 2018. The policy enables eligible healthcare facilities to claim ¥800 (approximately $5.7) per case wherein a rationale to not prescribe antibiotics is offered for children aged <3 years with acute upper respiratory tract infections or gastroenteritis. Although the short-term effect of this policy was observed in our previous study, its long-term effects have not been evaluated nationwide. Methods We conducted a quasi-experimental study using a staggered difference-in-differences design with propensity score matching. Data from 165 113 children born between April 2017 and March 2019 were extracted from 2 nationwide administrative databases. The study tracked these children until May 2022, comparing those exposed to the policy with those who were not. Results The introduction of financial incentives led to a 44.9% reduction (95% confidence interval, 41.1%-47.7%) in total antibiotic prescriptions within the first month and 19.5% reduction (8.7%-29.1%) over 48 months. Broad-spectrum antibiotic use also decreased by 24.4% (95% confidence interval, 14.0%-33.6%) over the same period. The policy did not result in increased hospitalizations, after-hours visits, or healthcare costs, but it was associated with a slight increase in the number of office visits. A dose-response relationship was observed, with reductions in antibiotic use leveling off after approximately 5 incentives. Conclusions Financial incentives effectively reduced antibiotic prescriptions in children without adverse health outcomes, demonstrating sustained benefits over 4 years. This antimicrobial stewardship intervention offers a scalable model for other countries aiming to curb antibiotic overuse and combat antimicrobial resistance.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Financial incentive policy enabling healthcare facilities to claim ¥800 (approximately $5.7) per case where a rationale for not prescribing antibiotics is offered to children aged <3 years with acute upper respiratory tract infections or gastroenteritis
- Population
- 165,113 children born between April 2017 and March 2019 in Japan; comparison between those exposed to the policy and unexposed controls
Key finding
44.9% reduction in total antibiotic prescriptions within the first month (95% CI: 41.1%-47.7%)