COMPARATIVE ANALYSIS OF SELECTED ESSENTIAL DRUG LISTS AZIZ JAFAROVRICHARD LAING

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COMPARATIVE ANALYSIS OF SELECTED ESSENTIAL DRUG
LISTSAZIZ JAFAROV/RICHARD LAING
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INRODUCTION/BACKGROUND

• Pharmaceuticals are one of the most expensive
  components of health care and may comprise up to
  40 percent of the health budget in developing and
  transitional countries. The Essential Drug
  concept was developed in order to help countries
  make best use of available finances for
  pharmaceuticals. The 1975 World Health Assembly
  Report recognized the urgent problems caused by
  lack of essential drugs in many countries. This
  was the first step towards developing the World
  Health Organization Model EDL. Two years later,
  WHO proposed the first Model List of Essential
  Drugs. Since 1977, the WHO list has been revised
  every second year, when some drugs are excluded
  and some others are added. The latest edition of
  the WHO ED Model List from 2002 contains 324
  active ingredients.
• Essential drugs are those drugs that satisfy
  the health care needs of the majority of the
  population they should therefore be available at
  all times in adequate amounts and in the
  appropriate dosage forms, and at a price that
  individuals and the community can afford

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INRODUCTION/BACKGROUND

• Correct selection and purchase of pharmaceuticals
  aims to improve the affordability and quality of
  health care to the population. Implementation of
  the ED concept starts with selection of drugs to
  be on the national EDLs. The primary criteria for
  inclusion are accurate clinical data on safety
  and efficacy of the drug, its availability, cost
  and cost-effectiveness. Ideally the selection
  process should be consultative and transparent
  the criteria should be explicit and linked to
  evidence-based clinical guidelines
• Since 1995, WHO/EURO has promoted the development
  of national essential drug lists for all of these
  Central Asian countries. All countries have
  developed such lists and it now appears timely to
  make a critical review of the selections made.

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METHOD

• The method used in this paper compares the
  existing Essential Drug Lists of Kazakhstan,
  Kyrgyzstan, Uzbekistan, and Tajikistan with the
  WHO Model EDL List. The WHO Model EDL includes
  the International Nonproprietary Names (generic
  names) and the form and doses recommended. The
  EDLs of the countries also have such information.
  At the same time, the EDLs of some of the
  countries, in addition to this information,
  includes trade names, which are the same as brand
  names. The WHO Model EDL sorts the drugs into 27
  therapeutic groups, with drugs identified as
  core or complementary. For the purpose of this
  analysis, we have combined core and complementary
  drugs into a single master list.

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METHOD

• For this paper a comparative table has been
  developed and the 1999 WHO Model EDL was taken as
  the standard. Drugs on national EDLs were
  classified as being 1) on the WHO Model EDL 2)
  From the same therapeutic group or 3) Not
  included on the WHO Model List. The numbers of
  the trade/brand names mentioned in the national
  lists (in the case of Tajikistan and Kazakhstan)
  were collected. In addition, drugs were compared
  with those in the WHO Model EDL.
• Based on the spreadsheet, summary tables were
  developed for all the EDLs and the WHO Model List
  and some of the therapeutic groups in order to
  compare with the national and the WHO list.

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RESULTS/FORM AND DOSES
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RESULTS/CARDIOVASCULAR DRUGS
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RESULTS/GASTROINTESTINAL DRUGS
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RESULTS/DRUGS AFFECTING THE BLOOD
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DISCUSSION

• The number of drugs in the four countries ranges
  from 236 to 369, including 136-200 drugs from the
  WHO Model List. Some of the WHO ML drugs are not
  included in any of the national lists. Instead,
  the national lists include other drugs, which
  raise the issue of evidence-based selection.
• Although the countries have similar disease
  indicators with about the same level of health
  financing, except for Tajikistan, the EDLs in the
  four countries vary substantially. This fact
  raises questions about the selection process of
  the essential drugs included in the national
  lists and perhaps to a certain extent questions
  whether the drugs included in the WHO Model List
  are the right ones.
• Choices of cardiovascular and gastrointestinal
  drugs are among the most controversial among the
  countries. Why are the choices so different?

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DISCISSION

• The different choices made about cardiovascular
  drugs and gastrointestinal drugs show that the
  countries do have their own opinions and are not
  pressured by WHO and other health organizations
  involved in the development and updating of the
  EDLs to conform to the WHO Model EDL. This
  suggests that at least in some of the countries,
  the selection may not be evidence-based.
• Some countries, in addition to the generic name
  column, included a column for brand name options.
  Perhaps this column is included for educational
  purposes, because some health professionals are
  not familiar with generic names. But inclusion of
  brand names for most of the drugs in the list can
  lead to misinterpretation, particularly in
  procurement and prescription practices. Including
  a brand name in the EDL limits the procurement
  option to that particular brand name.
• What is the right number of forms and doses for a
  drug? For most of the drugs, WHO suggests two
  forms and dosages. For example, compared to the
  WHO average of 1.9 dosages per drug, Kyrgyzstan
  averages 3.6 and Uzbekistan 3.5. But the national
  lists of some of the countries show much higher
  numbers. How necessary is it to have 14 forms and
  doses of paracetamol?

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CONCLUSION

• There has been a significant effort by the
  countries to implement the ED Concept. All of the
  four countries have developed and revised their
  EDLs. The total number of drugs included in the
  national lists is reasonable. Local institutions
  contributed to the process of the development and
  revision of the lists, and there is knowledge and
  interest in the ED concept. The number of
  essential drugs among the four countries, the
  drugs selected for the national lists, and the
  excessive number of forms and doses make the
  lists controversial.
• WHO is moving towards evidence-based medicine,
  and the organization is still strongly involved
  in the process of developing and revising the
  EDLs. Perhaps the EDL concept will bring benefits
  if the WHO will develop comprehensive guidelines
  on evidence-based selection and create a database
  on essential drugs. This will facilitate the
  selection process in the countries, which are
  deficient in human resources and have limited
  financial capacity.
• The EDLs of the countries are very different. At
  least some of their selected drugs and the
  selection process itself require radical
  revision.