For a correct assessment of the magnitude and trends of antimicrobial consumption in the country or area and to allow comparison of results across the AMC Network and with other international data sets, the data are required to be both valid and reliable. The validity and reliability of data may be compromised at different points, however. These include:
• incomplete registration of antimicrobial products in circulation in the country or area
• incomplete capture and reporting of data
• double counting of medicines from different data sources
• errors in data entry that were not identified during data validation
• failure to account adequately for export of locally produced antimicrobial agents
• data excluded from calculations where no ATC or DDD is assigned for the medicine.
Together, these errors will affect the absolute values for antimicrobial consumption (measured in DID).
Incomplete data capture may occur when not all wholesalers provide data on products sold.
Sales data from local manufacturers need to distinguish between medicines for local consumption and medicines exported.
No ATC or DDD is assigned to a considerable number of products in several countries and areas participating in the WHO Europe AMC Network. Consumption of these medicines is excluded from the analyses reported here, meaning that total consumption estimates presented will underestimate actual consumption of antibacterials. The WHO Regional Office for Europe is working with participants in the WHO Europe AMC Network and the WHO Collaborating Centre for Drug Statistics Methodology to identify products without codes and to resolve these for future analyses.
3�4�1 Import data
An issue with data derived from importation records is that the estimates will be affected by the cycles of procurement and delivery. This may give rise to fluctuations in estimates of consumption that do not relate to use of antibacterials by patients and health-care facilities.
Import cycles are also likely to mean that different products are received at different times, so relative use estimates may also be affected. Notwithstanding these limitations, it is reasonable to assume that over a longer period the relative use estimates will stabilize and more closely reflect the relative consumption of different antibacterial agents. Consequently, trends over time need to be interpreted carefully. In general, import data should not be used to make comparisons on monthly or quarterly consumption.
The analyses in this report provide annual consumption estimates. The fluctuations in total consumption estimates from several countries and areas, however, suggest that import cycles may contribute in part to the patterns of consumption shown. In the absence of universal health coverage or e-prescribing, widespread availability of antibiotics without prescription, few mechanisms to engage private wholesalers and limited ability to disaggregate data to hospital and community sectors, import records remain the most feasible data source in most AMC Network countries and areas.
3�4�2 Information value
The data presented may not yet be optimal, or systemic issues may lead to biased estimates, but recognizing these limitations may encourage the use of different data sources, such as wholesaler rather than import data. Later, as information systems develop, it may be possible to derive consumption estimates from reimbursement records from health insurance agencies and e-prescribing platforms.
Already the situation is changing, with several countries and areas now reporting data disaggregated to community and hospital sectors and a number with the ability to use health insurance data to assess patterns of use of antimicrobials.
Even with the data limitations, the variability of consumption patterns within and between countries and areas provides a basis for further investigation to better understand how antibacterials are used in practice. The consumption data need to be interpreted with an understanding of the local context, taking account of changes in regulations (including enforcement of prescription-only access), data sources, resistance patterns and the potential impact of interventions to change practices.
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4. ALBANIA
4�1 Data source and years of data collection
Albania has provided data for each of the seven years of data collection (2011–2017). The main sources of data are import records provided by the drug agency.