Cross-sectional studyindependent cross-checkabstract checked I-ABX-130 standard review
About a quarter of US antibiotic fills were inappropriate in 2016
Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study.
Overview
Chua KP et al.. BMJ 2019 · PMID 30651273 · DOI 10.1136/bmj.k5092
23% of outpatient antibiotic fills had no diagnosis justifying them.
Does the study support the specific claim? Yes · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Measure inappropriate antibiotic prescribing
- How was the study done?
Insurance claims analysis
- How many people, animals or samples were studied?
19.2 million people
- What was actually found?
23.2% inappropriate
- How large was the observed effect?
23.2%
- What do the results mean in everyday life?
Overprescribing persists
- What are the study's limitations?
Coding-based
- What does it say about Elawady's specific claim?
Supports the claim's general point
- Do the results apply to Germany and Europe?
Low
- What can explicitly not be concluded from this study?
Rates outside the US
Scientific in-depth review
1. Full reference
- Authors
- Chua KP et al.
- Journal
- BMJ
- Year
- 2019
- Identifier
- PMID 30651273 DOI 10.1136/bmj.k5092
- Verification
- verified – PubMed efetch 2026-10-26 + Crossref
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
AHRQ funding; no competing interests (record).
2. Research question
How appropriate is outpatient antibiotic prescribing among privately insured US patients?
3. Study design and population
- Study design
- Cross-sectional study – Cross-sectional claims analysis
- Population
Privately insured enrollees aged 0-64
- Country
USA
- Period
2016
- Sample size
19,203,264 enrollees; 15,455,834 fills
- Inclusion and exclusion criteria
MarketScan claims
4. Methods and endpoints
- Exposure / intervention
Antibiotic fills classified by diagnosis codes
- Comparator
not applicable
- Endpoints
Appropriate / potentially appropriate / inappropriate / no diagnosis
- Statistical methods
Descriptive
5. Actual results
- Results
12.8% appropriate, 35.5% potentially appropriate, 23.2% inappropriate, 28.5% not associated with a recent diagnosis code; 14.1% of enrollees filled at least one inappropriate prescription.
- Absolute risks
23.2% of fills inappropriate
- Authors' conclusion
23.2% inappropriate and 28.5% without a recent diagnosis; about 1 in 7 enrollees filled at least one inappropriate prescription.
6. Strengths
- Very large
- Comprehensive classification
7. Weaknesses
- Claims coding
- Privately insured only
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Coding misclassification possible.
9. Assessment of the statistical interpretation
Different method, similar order of magnitude to 30%.
10. Relevance to the specific claim
Independent later confirmation of large-scale overprescribing.
11. Independent contrary findings
Estimate depends on classification.
12. Transferability to Germany and Europe
Low (US).
13. Overall methodological judgement
Corroborates the general point.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | high |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | low |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
None.