E-DRUG: Hydroxocobalamin injection, not an essential medicine (4)
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Dear e-druggers,
In reaction to Chris's remark that cost and availability could be the reason
for using/listing the vitamine B12 injection we submit the following.
Evidence is conclusive that oral (1mg tablet daily) and intra-muscular (1mg
injection monthly) treatment with cobalamin are equally efficacious.
However, risks and patients' discomfort of the life-long treatment are
considerably higher with injections.
Our own study in Suriname found significantly higher costs with the use of injections due to the need for consultation of health workers to obtain prescriptions and to apply the injections.
Farmaco-economic studies in Ontario, Canada (one of the few
places where the tablets are considered essential) found that the oral
treatment is more cost-efficient than injections.
There are few countries that have described or registered Vitamin B12
tablets as medicines in the required strength of 1mg. However, most
countries, if not all, have these tablets on the market as vitamin products
from multiple sources.
Given the above, we see no valid reason for the WHO and medicines selection
committees to refrain from de-listing the vitamin B12 injection as
essential medicine and list the 1mg tablets instead.
Best regards,
Rob Verhage,
Pharmacist,
Hera Senior Partner - Pharmaceutical systems consultant (
www.hera.eu),
Tawajakoerastraat 4, Paramaribo, Suriname; +597
Frank Bueno de Mesquita, Paediatrician, Director of the 'Foundation for
Promotion of Evidence-based Medicine in Suriname'
Paramaribo, Suriname
rob verhage <verhager@gmail.com>