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Assessing the Differences in Outpatient Antibiotic Consumption Between Reimbursement and Sales Data in Belgium, 2013-2022
No full textIn Belgium, surveillance of antimicrobial consumption (AMC) is traditionally assessed through reimbursement data, excluding over-the-counter, non-reimbursed or imported products, and it is obtained with a time lag. This study investigates differences in AMC in the primary care sector between reimbursement and sales data, aiming to provide insights into AMC variations and to quantify the accuracy of current surveillance methods.
Method
Data. Reimbursement data for systemic antibacterials (ATC group J01) were obtained from the National Institute for Health and Disability Insurance (NIHDI) and contains all reimbursed products dispensed in outpatient pharmacies. Retail sales data were sourced from IQVIA and contains all pharmaceutical products purchased by dispensing pharmacies from wholesalers.
Measures. The AMC volume was measured in defined daily doses per 1000 inhabitants per day (DID), using as denominator total population data from Eurostat.
Analysis. Bland-Altman plots were used to assess the agreement in DID between reimbursement and retail datasets. Relative differences in DID (RD) between the two datasets were computed for the J01 group and its ATC-3 subclasses.
Results
1. Agreement between datasets
•The results show high agreement between the two datasets, with a mean difference (DID based on retail minus DID based on reimbursement) of 0.1.
•Substantial outliers were observed for fluoroquinolones (J01M) for the years 2018, 2019, 2020 and 2021 and 2022.
2. Consumption of antibacterials for systemic use (J01)
•J01 antibacterial sales declined from 22.89 DID in 2013 to 20.50 DID in 2022 (-10.4%), with and a notable deviation during the Covid-19 pandemic – dropping from 21.31 DID in 2019 to 16.55 in 2020 (-22.3%) (Figure 2, Graph B).
•Reimbursement data slightly underestimated retail data with RDs ranging from 2% (2013) to 9% (2022) when including fluoroquinolones (Graph C) and 2 to 4% when excluding them (Graph D).
3. Consumption of antibacterials for systemic use at ATC-3 level
•Highly similar ten-year trends were observed in both datasets for five out of the nine subclasses: J01A, J01C, J01D, J01E, J01F, and J01X.
•Striking relative differences were observed for substances consumed in low quantities (<0.5 DID), such as amphenicols (J01B), aminoglycoside antibacterials (J01G) and sulfonamides and trimethoprim (J01E).
•Reimbursement and retail datasets show similar consumption levels until 2017 for quinolones (J01M), after which high RD variations emerge.
Conclusion
Reimbursement data serves as a reliable tool for outpatient AMC monitoring, with only slightly lower estimates than sales data across most J01 subclasses. However, a notable exception is observed with quinolones due to a 2018 governmental change in reimbursement criteria aimed at reducing their consumption. This highlights the importance of incorporating sales data for accurate assessments in this specific category. The synergistic use of both reimbursement and sales datasets is essential for gaining a comprehensive understanding of consumption patterns and for supporting AMR mitigation strategies in Belgium.</p
Persistent defect in SARS-CoV-2 humoral and cellular immunity in lung transplant recipients.
No full textLung transplant recipients (LTR) are susceptible to severe COVID-19 and had lower immune responses to primary SARS-CoV-2 vaccination as compared to the general population and to other solid organ transplant recipients. As immunity induced by booster vaccination and natural infection has increased since the beginning of the pandemic in the general population, immunity acquired by LTR is not well documented. Humoral and cellular immunity to SARS-CoV-2 was monitored in February and May 2023 in 30 LTR and compared to that of health care workers (HCW) and nursing home residents (NHR). LTR had significantly lower levels of SARS-CoV-2 binding and neutralizing antibodies and lower IFN-γ responses to Wuhan, Delta and XBB1.5 variants as compared to HCW and NHR. Humoral immunity decreased between the two visits whereas cellular immunity remained more stable. The persistent defect in SARS-CoV-2 immunity in LTR should encourage continued monitoring and preventive measures for this vulnerable population.</p
Evaluation of an electrochemical sensor and comparison with spectroscopic approaches as used today in practice for harm reduction in a festival setting—A case study: Analysis of 3,4‐methylenedioxymethamphetamine samplesAbstract
No full textMore and more countries and organisations emphasise the value of harm reduction
measures in the context of illicit drug use and abuse. One of these measures is drug
checking, a preventive action that can represent a quick win by tailored consultation
on the risks of substance use upon analytical screening of a submitted sample. Unlike
drop-in centres that operate within a fixed setting, enabling drug checking in a harm
reduction context at events requires portable, easy to use analytical approaches,
operated by personnel with limited knowledge of analytical chemistry. In this case
study, four different approaches were compared for the characterisation of
3,4-methylenedioxymethamphetamine samples and this in the way the approaches
would be applied today in an event context. The four approaches are mid-infrared
(MIR), near-infrared, and Raman spectroscopy, which are today used in drug checking
context in Belgium, as well as an electrochemical sensor approach initially developed
in the context of law enforcement at ports. The MIR and the electrochemical
approach came out best, with the latter allowing for a direct straightforward analysis
of the percentage 3,4-methylenedioxymethamphetamine (as base equivalent) in the
samples. However, MIR has the advantage that, in a broader drug checking context,
it allows to screen for several molecules and so is able to identify unexpected active
components or at least the group to which such components belong. The latter is also
an important advantage in the context of the growing emergence of new psychotropic
substances.</p
Which government policies to create sustainable food systems have the potential to simultaneously address undernutrition, obesity and environmental sustainability?
No full textPrevalence of obesity in people with and without type 1 diabetes across Belgium, Kuwait, and Mexico: an IMI2 SOPHIA study
No full textImpact in Belgium of the ban on opium production in Afghanistan. Workshop report: Foresight exercise with scenario development
No full textBY-COVID D5.1 Enriched report viral variants and health outcomes
No full textExecutive summary
BY-COVID Work Package (WP) 5 develops multiple use cases to address evolving research questions that arise during a pandemic, requiring data from multiple domains, sources, and countries. This evolving BY-COVID demonstrator is continuously enriched with new data, new evidence, and new hypotheses as part of Task 5.1. The use cases implemented in Task 5.2, Task 5.3 and Task 5.4 serve as concrete examples of adaptable and responsive workflows and methodologies designed to tackle the changing research challenges of a pandemic.
The ‘Baseline Use Case’ developed in Task 5.2 provides a standard workflow, methodology and supporting technology that enables it to address any well-defined research question relevant for policy making. The proposed use case aims to demonstrate how mobilisation and linkage of heterogeneous real-world population data sources hosted at multiple sites can enhance the understanding of the direct and indirect effects of the pandemic on health outcomes in populations crossing jurisdictional borders. The proposed methodological framework provides guidance in the form of a systematic approach to address federated cross-national causal research questions in a privacy-preserving way, while tackling challenges at different layers of interoperability (legal, organisational, semantic, technical). This flexible workflow can evolve with new data types (e.g., socioeconomic and genomic), new data sources (e.g., registries, bio-samples, surveillance systems), new sites (e.g., other countries), and new hypotheses (e.g., COVID-19 Disease Maps). </p
Epidemiologische surveillance van invasieve pneumokokkeninfecties (IPD) - 2019 tot 2022
No full textHoofdpunten
Sinds de introductie van pneumokokken vaccins in de kindervaccinatie programma’s in 2007 daalde de Invasieve Pneumokokken Ziekte (IPZ/IPD, Invasive Pneumococcal Disease)-incidentie bij kinderen jonger dan 2 jaar. Initieel werd gevaccineerd met PCV7 gevolgd door PCV13 vanaf 2011.
Van 2011 tot 2015 werd er een daling vastgesteld voornamelijk bij kinderen.
Nadat PCV13 vervangen werd door PCV10, van 2016 tot 2019, steeg de incidentie. De stijging was meest uitgesproken bij jonge kinderen en voornamelijk geassocieerd met PCV13 serotypes die niet vervat zaten in het 10-valent vaccin (3, 6A, 19A, PCV13nt10). Gedurende de COVID-19 epidemie (2020-2021) was er een algemene daling van de circulatie van respiratoire pathogenen, waaronder dus ook S pneumoniae.
Sinds 2019, het jaar van de herintroductie van PCV13 in de basisvaccinatie, is er een daling van PCV13nt10 serotypes bij jonge kinderen.
In 2022 was er bij oudere personen en voor serotypes niet opgenomen in PCV13 een stijging van de incidentie tot het niveau van voor de COVID-19 epidemie.
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