Estudio de la oferta de medicamentos en el sistema de salud público de México. La dinámica de mercado de los medicamentos oncológicos.

Abstract

Introduction - The use of unsafe and ineffective medicines, besides their unsustainable costs, is a global concern especially regarding the new anticancer medicines or rheumatoid arthritis treatments. The inappropriate use of medicines represents a waste of resources for patients and institutions, as well as the exposure to unreasonable risks. To improve the use of medicines, the health authorities established instruments such as national formularies (NF) or clinical practice guidelines (CPG). Unfortunately, these tools present problems either in content, therapeutic recommendations or implementation. In Mexico, the NF is the reference instrument to meet the needs of more than 112 million inhabitants. In order to promote the rational use of medicines, the Ministry of Health developed and updated over 700 CPGs recently. To date, the content of the NF and its concordance with the CPGs recommendations have not been evaluated. The objectives of the present analysis were: to study the offer and rationality of the NF; to understand and describe its composition, configuration process and concordance with the GPCs, focusing in some groups such as the new Oncology treatments._x000D_ Methods - Drug utilization studies to analyze: (1) the coverage of basic needs and oversupply of medicines in the NF 2010 according to the recommendations of the WHO Model List of Essential Medicines (LEM), and the added therapeutic value for each drug according to the evaluations of Prescrire; and (2) the conformation of the NF between 1996 and 2013, through the analysis of the top-10 indications with the highest number of medicines (Top-10). Additionally, an analysis of the evolution of spending on oncologic medicines was performed._x000D_ Results - On the one hand the NF lack 14.0% of the essential medicines recommended by the LEM and, on the other hand, 47% of the included medications were considered an oversupply, especially medicines without added therapeutic value and me-too. From 1996 to 2013 the NF increased steadily the number of medicines, which were concentrated in a few indications of use: 26% of the offer were medicines to be prescribed only for the Top-10 indications (three tumors, rheumatoid arthritis and diabetes, among others). Furthermore, a quarter of the medicines included in the NF were not among those recommended by the CPGs. _x000D_ Conclusions The Mexican NF is characterized by a double pattern of irrationality: it lacks essential medicines to attend prevalent diseases and includes an oversupply of medicines with little or any additional therapeutic value. In the last two decades the approved medicines and their indications of use in the NF were concentrated in a limited number of indications of use, a fact that reduces the quality of medicines supply and increases the possibility of selection and prescription errors.

Date of Award	15 Jul 2015
Original language	Undefined/Unknown
Supervisor	Albert Jesús Figueras Suñé (Director)