Can poor countries help rich countries contain drug costs?

Rich countries could follow the lead of poor countries and adopt a more systematic way of selecting medicines for reimbursement, according to a paper in this week's BMJ.

Rising costs of drugs is universal. From 1998 to 2001, prescription costs in the United States and England increased by 62% and 30% respectively. Yet, since the 1970s, many developing countries have set up national lists of essential medicines, which aim to increase access to medicines, promote better health and contain costs.

Could the essential drugs concept help rich countries to control the rise in drug costs?

Faced with these spiralling costs and increasing demands for quality health care by ageing populations, industrialised countries would do well to consider and adopt these approaches, writes Hans Hogerzeil of the World Health Organization. Essential medicines are not second rate medicines for poor people; they are the most cost-effective treatment for a given condition, he stresses.

Essential drug lists or formularies are already widespread in rich countries, say experts in an accompanying commentary. But there are trade-offs: limitations on choice of drug may save money, but if rigorously applied, some patients will be affected.

Drug lists also need integration into clinical guidelines, which can improve care but not necessarily cut cost, they add. For instance, in the United Kingdom, National Institute for Clinical Excellence guidelines and setting national standards have increased prescribing costs, they add

"We should learn from the experience of those implementing the concept, but adaptation must be sensitive to different environments," they conclude.

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