Estudio de la oferta de medicamentos en el sistema público de méxico. La dinámica de mercado de los medicamentos oncológicos
- Autores: Israel Adan Rico Alba
- Directores de la Tesis: Albert Figueras (dir. tes.)
- Lectura: En la Universitat Autònoma de Barcelona ( España ) en 2015
- Idioma: español
- Tribunal Calificador de la Tesis: Antonio Vallano Ferraz (presid.), Gonzalo Calvo (secret.), Dolors Capellà Hereu (voc.)
- Materias:
- Enlaces
- Resumen
Introduction The use of unsafe and ineffective medicines besides their unsustainable costs are global concerns, especially in the new anticancer medicines or rheumatoid arthritis treatments. The consequences of the inappropriate use of medicines represent 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 had been established instruments such as national formularies (NF) and clinical practice guidelines (CPG). Unfortunately, these tools have problems in content, therapeutic recommendations or their implementation. In Mexico, its NF is the reference instrument to meet the needs of more than 112 million inhabitants. In order to promote the rational use of medicines, recently, the Ministry of Health developed and updated over 700 CPG¿s. To date, the contents of the NF and concordance with the CPG recommendations have not been evaluated. The analysis performed had the objectives of study the offer and rationality of the NF; besides understand its composition, conformation process and concordance with the GPC, with emphasis in some groups such as the new drugs used in oncology.
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 Model List of Essential Medicines (LEM) of WHO, and the added therapeutic value for each drug according to the evaluations of the journal Prescrire (2) the configuration 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.
Results On one hand the NF lacks 14.0% of the essential medicines recommended by the LEM and, on the other hand, 47% of the including medications are considered an oversupply, especially medicines without added therapeutic value and me-too. From 1996 to 2013 the NF increased steadily their number of medicines, which were concentrated in a few indications of use: a 26% of the offer were medicines to use only in the top-10 indications (Three tumors, rheumatoid arthritis and diabetes, among others). Furthermore, a quarter of the offer medicines in the NF are not among those recommended by the CPG.
Conclusions The Mexican NF is characterized by a double pattern of irrationality: 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 around a limited number of indications which reduces the quality of medicines to be supply and increases the possibility of errors in prescription.
