E-drug: Essential Drugs list for Greece (cont'd)
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I think the key concept in drug selection is described in the new edition
of Managing Drug Supply. This is :
1. Start with a list of the most common conditions that afect 90 to 95% of
treatment episodes.
2. Agree on treatment guidelines for these conditions. This is likely to
include first, second and third line treatments. While safety and efficacy
should be primary consideration cost effectiveness should be a secondary
criteria. This should include all costs not just drug costs. Thus if a more
expensive drug reduces hospital stay it could be considered a better
treatment.
3. Based on these two lists generate your drug list. This will be the core
of your drug list that everybody can easily agree to.
Then review peoposals for drugs which should be added to the list on the
basis of need. This can include consideration of cost effectiveness and
rare conditions such as poision antidotes, orphan conditions etc.
But if you start from morbidity and treaetment guidelines you have a much
better chance of developing an essential drug list that is based on facts
not opinions. The worst approach is to have a group of senior clinicians
sitting around saying "In my experience this is a good drug that should be
included on the list." Another thing to avoid is to have the drug industry
involved in the discussions. Ask them to provide comparitive cost and
effectiveness data but do not allow them to participate. Commercial
interests may conflict with clinical or cost effectiveness decisions.
I would be interested in other experiences of this process.
Richard Laing
Associate Professor
Department of International Health
Boston University School of Public Health
715 Albany St
Boston MA 02118-2526
Tel 617 414-1444
Fax 617 414-1442 or 638-4476
e-mail: richardl@bu.edu
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