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

Nurzhamal Akhmadyar 1 * , Bulat Kupenov 2, Berik Konakbay 1, Saule Burkitbayeva 1, Zhandaulet Zhaxylykuly 1
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1 Department of Clinical Pharmacology, Astana Medical University, Astana, Kazakhstan
2 Deputy Chairman of the board on medical activities, National Scientific Medical Center, Astana, Kazakhstan
* Corresponding Author
J CLIN MED KAZ, Volume 23, Issue 5, pp. 20-26. https://doi.org/10.23950/jcmk/19621
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Author Contributions: Conceptualization, N.S.A., B.G.K., B.K.K.; methodology,  N.S.A., B.K.K., S.S.B., Zh.Zh.; validation,  B.K.K., Zh.Zh.; formal analysis,  N.S.A., B.G.K., B.K.K., Zh.Zh.; investigation,  N.S.A.; resources,  B.K.K., N.S.A.; data curation,  N.S.A.; writing,  original draft preparation,  B.K.K., S.S.B., Zh.Zh.; writing,  review and editing,  B.K.K., S.S.B., N.S.A.; visualization,  S.S.B., Zh.Zh.; supervision,  B.K.K., N.S.A.; project administration,  B.K.K., N.S.A. All authors have read and agreed to the published version of the manuscript.

Data availability statement: Item-level data and all calculations underlying Tables 1–8 are provided in Supplementary File S1. The original pharmacy ledgers contain commercially sensitive procurement details and are available from the corresponding author on reasonable request and with institutional approval.

Artificial Intelligence (AI) Disclosure Statement: Generative AI tools were used for language editing, manuscript structuring and assistance with data processing code. The authors take full responsibility for the content and verified all data, analyses, interpretations and references.

ABSTRACT

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.
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;

 
Keywords: Drug costs, Drug utilization, Anti-bacterial agents, Antimicrobial Stewardship, Tertiary Care Centers, Formulary management

CITATION

Akhmadyar N, Kupenov B, Konakbay B, Burkitbayeva S, Zhaxylykuly Z. Drug costs and antibiotic stewardship in a tertiary care hospital in Kazakhstan: ABC/VEN, 2022–2025. J CLIN MED KAZ. 2026;23(5):20-6. https://doi.org/10.23950/jcmk/19621

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