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.

Abstract

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. 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. 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. 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.