Drug costs and antibiotic stewardship in a tertiary care hospital in Kazakhstan: ABC/VEN, 2022–2025

Abstract
Introduction: Multi-year hospital-level data on drug expenditure in Kazakhstan are scarce, although antimicrobial resistance and the growing use of high-cost biologics require expenditure monitoring tools. This study aimed to quantify four-year trends in drug expenditure, formulary structure and antibiotic spending in a multidisciplinary tertiary care hospital.
Materials and Methods: Annual pharmacy dispensing ledgers for 2022–2025 were analyzed retrospectively. Each item was assigned an International Nonproprietary Name and an Anatomical Therapeutic Chemical code. ABC analysis and vital, essential and non-essential classification were performed by nonproprietary name, and antibacterials were mapped to the World Health Organization Access, Watch and Reserve groups. Expenditure was normalized per bed-day.
Results: The number of nonproprietary names dispensed decreased from 194 to 172, whereas expenditure increased by 40.6% to 523.8 million Kazakhstani tenge and expenditure per bed-day by 35.1%. The share of immunosuppressants rose from 2.9% to 22.8%; ustekinumab and vedolizumab accounted for 20.3% of expenditure in 2025. Group A comprised 15.1–19.1% of names and 80.0–80.8% of expenditure; no non-essential medicine entered group A, but non-essential expenditure increased to 1.9% in 2025. Antibacterial expenditure rose by 66.6% in 2025; Watch agents accounted for 75.5–78.1% and Reserve agents for 10.3–14.4% of antibacterial spending.
Conclusions: Formulary contraction coincided with a shift of the budget toward biologics and Watch and Reserve antibiotics. The findings are limited by the single-center design, nominal prices and the absence of consumption metrics based on defined daily doses; expenditure-based Access, Watch and Reserve signals should be combined with such metrics in multicenter studies.
Keywords: Drug costs; Drug utilization; Anti-bacterial agents; Antimicrobial Stewardship; Tertiary Care Centers; Formulary management;