Drug utilization studies public health responses global perspective on a vital link

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Drug utilization studies public health
responses- global perspective on a vital link

EURODURG Meeting Prague, June 2001 Integrating
drug utilisation studies in a wider Europe
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People needlessly suffer and die when medicines
are unavailable, unaffordable, unsafe, or
improperly used

• Access
• 1/3 of the worlds 6 billion people lack regular
  access to essential drugs
• 75 of drug spending is out-of-pocket in
  developing countries
• treatment of simple pneumonia may cost 3 months
  wages in Africa
• Quality
• substandard and counterfeit drugs continue to
  kill
• poor quality drugs circulate freely in many
  countries
• roughly 1/3 of countries have a fully operational
  regulatory body
• Rational use
• 95 of primary care injections are unnecessary in
  many settings
• 25-75 of antibiotic prescriptions inappropriate
• only 52 of 102 countries surveyed regulate drug
  promotion

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WHO Medicines Strategy 2000-2003 Highlights on
current issues and drug utilisation
WHO Medicines Strategy priority on access to
essential drugs

• Current issues Essential drugs list,
• Antimicrobial resistance, Access to newer drugs

WHO Information Service
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WHO Medicines Strategy 2000-2003 Highlights on
current issues and drug utilisation
WHO Medicines Strategy priority on access to
essential drugs

• Current issues Essential drugs list,
• Antimicrobial resistance, Access to newer drugs

WHO Information Services
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WHO essential drugs medicines strategy -4
objectives guide country, regional, global work

• 1. National Drug Policy
• guide to coordination of action by all
  stakeholders
• 2. Access
• selection, financing, pricing, supply systems
• 3. Quality and safety
• standards, effective regulation, information
  support
• 4. Rational use
• health professionals and consumers, public and
  private

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Can drug utilization studies (DUS) contribute to
the implementing the WHO Medicines Strategy?

• National Drug Policy
• DUS can contribute to making evidence based
  policy decisions
• Access
• DUS can help demonstrate rate of access to the
  drugs
• DUS can help to optimize procurement and
  reimbursement lists
• Quality and safety
• DUS can contribute to the decision making in
  relation to drug safety
• Rational use
• DUS have tremendous value for all aspects of
  rational drug use as they provide evidence based
  feedback how drugs are used

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WHO Medicines Strategy 2000-2003 Highlights on
current issues and drug utilisation
WHO Medicines Strategy priority on access to
essential drugs
Current Issues Essential drugs list,
Antimicrobial resistance, Access to newer drugs
WHO Information Service
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The essential drugs concept is becoming universal
- 156 countries with EDL - over 100 treatment
guidelines
Essential drugs list
156 countries with EDLS 1/3 within 2 years 3/4
within 5 years
Countries with an official selective list for
training, supply, reimbursement or related health
objectives. Some countries have selective
state/provincial lists instead of or in addition
to national lists.
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Observations about the current approach to the
WHO Model List
Essential drugs list

• Range of diseases covered by the Model List is
  not clear
• Discrepancies between WHO Model List and WHO
  clinical guidelines
• Selection is more consensus-based than
  evidence-based
• Use of data on cost and cost-effectiveness
  unclear
• Reasons for selection insufficiently recorded
• Drugs included without pharmacopoeal standard or
  supplier

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Systematic approach to produce the Model List and
a WHO Essential Drugs Library
Essential drugs list
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Aspects of the process under consideration
Essential drugs list

• Model process more systematic, more open
  consultation, more structured involvement experts
• Two lists
• Core list - minimum drug needs for a basic health
  care system
• Complementary list - cost-effective but not
  affordable special diagnostic skills/facilities
  essential drugs for less frequent diseases
• Proactive review of entire therapeutic groups
• Participation of health care industry and patient
  advocacy
• Providing information and views on proposed
  changes in the list?
• Participating at decision-making meetings?

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Resistance varies greatly among countries -growth
of resistance can be dramatic
Antimicrobial resistance
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Containing resistance is crucial for drugs to be
affordable and common diseases to remain treatable
Antimicrobial resistance
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Global strategy for containing antimicrobial
resistance 2001 - a framework for action
Antimicrobial resistance

• Developed with over 30 professional bodies,
  international organizations, NGOs, national
  programmes
• Identifies actions for patients, community,
  prescribers, dispensers, hospitals,
  food-producers, governments, industry
• Multi-pronged strategy - prioritize responses to
  therapeutic, behavioral, economic, health system,
  food-production factors
• Specific WHO activities
• Raising awareness - prescribers and consumers
• Assisting countries with national responses and
  surveillance
• Promoting information sharing and networking
• Providing strategic technical guidance on
  interventions
• Stimulating research to fill knowledge gaps

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Advocacy, corporate responsiveness, market
forces have reduced antiretrovial prices 95 in 2
years
Access to newer drugs
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Cost per disability adjusted life year gained,
selected HIV/AIDS intervention Africa, Year 2000,
US
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Increasing access to essential drugs for
priority health problems - framework for
coordinated action
Access to newer drugs
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UN framework for action -Access to HIV-Related
Drugs
Access to newer drugs

• 1. Rational selection and use - define what is
  most needed
• Selection based on local needs drug efficacy,
  safety, quality, cost
• Appropriate use by health professionals and PLWA
• 2. Affordable prices - promote competition
  reduce costs
• Best prices through price information,
  negotiation, competition
• Reduction of duties, taxes, and distribution
  costs.
• 3. Sustainable financing - increase sustainable
  funding
• Advocacy for government external resources to
  HIV/AIDS
• Funds should be additional - not from prevention
  or other priorities
• 4. Reliable health and systems - ensure quality
  availability
• Diagnosis and treatment monitoring at health
  facilities
• Supply, regulation, and quality assurance systems

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Therapeutic competition, differential pricing,
and other measures can lower prices for those in
need
Access to newer drugs
Indicative target monthly prices for a specific
cardiovascular therapy, based on drug performance
and GNP per capita

• Country GNP per capita Target Monthly Price
• Bangladesh 359 0.14
• India 461 0.18
• Armenia 500 0.20
• China 826 0.32
• South Africa 3,112 1.22
• Brazil 4,541 1.79
• Canada 20,000 7.87
• Australia 20,511 8.07
• Belgium 24,088 9.47
• USA 31,880 12.54

Source D. Henry, WHO-WTO Workshop on
Differential Pricing and financing of Essential
Drugs, 2001
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WHO Medicines Strategy 2000-2003 Highlights on
current issues and drug utilisation
WHO Medicines Strategy priority on access to
essential drugs

• Current Issues Essential drugs list,
• Antimicrobial resistance, Access to newer drugs

WHO Information Services
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WHO Information Service http//www.who.int/medici
nes/
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Summary - Drug utilization studies have a vital
link to public health responses
WHO Medicines Strategy Tackling policy, access,
quality and safety, rational drug use

• Some current issues Modernizing essential drugs
• list, Containing antimicrobial resistance,
• Promoting access to newer drugs

WHO Information Services Increasingly direct
support to countries and professionals via WHO
Webpages
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