Comparative Analyses of China National & Twenty-two Selected Provincial Essential Medicine Lists to the WHO 2011 Model List
(2011; 264 pages)

Abstract

Essential medicines are defined as those that satisfy the priority health care needs of the population. They are selected with due regard to public health relevance, evidence on efficacy and safety, and comparative cost‐effectiveness. Medical and economic efficiency are advantages of EMLs. Since 1977, WHO has produced a WHO Model List of essential medicines every two years. The main purpose of the WHO Model List is to serve as evidence based transparent identification of a ‘common core’ of essential medicines, which has universal relevance and applicability. The latest version of WHO Model List was produced in March 2011. With the example of the WHO Model List, National Essential Medicine Lists (NEMLs) are formulated according to the country’s public health needs, availability, cost, cultural acceptability, and legal circumstances. China published its latest National Essential Medicine List (NEML) for primary health facilities on August 18, 2009.

The main objective of this research paper is to comparatively analyze China 2009 NEML and twelve selected China 2010 Provincial Supplementary EMLs (PEMLs) with the WHO 2011 Model list. Based on data availability, China 2010 PEMLs under scrutiny are from 22 provinces including Anhui, Chonqin, Shanghai, Shaanxi, Zhejiang, Heilongjiang, Henan, Jiangsu, Guizhou, Hebei, Qinghai, Yunan,Shandong, Sichuan, Shanxi, Gansu, Hubei, Guangdong, Hunan, Fujian, Inner Mongolia and Xinjiang autonomy district. There are 145 molecules on both the WHO 2011 Model List and China 2009 NEML, 213 medicines are only on WHO 2011 Model list, but not on China 2009 NEML. 101 Western medicines are only on China 2009 NEML, but are not on WHO 2011 Model List. Overall, 134 medicines are on both the WHO 2011 Model List and the twelve China 2010 PEMLs; 126 molecules are on the WHO 2011 Model List only; 523 molecules are on China PEMLs only; 47 molecules are duplicates of items on the WHO 2011 Model List, China 2009 NEML, and China 2010 PEMLs; 19 molecules are duplicates that appeared both on the China 2009 NEML and China 2010 PEMLs with additional forms.

The selection process and types of EMs were found to be key differences between the WHO Model List and China EMLs. The WHO Model List employs a systematic transparent approach with evidence based selection; while, China follows expert based methods on EMs selection. Only primary care medicines were covered under China 2009 NEML, while the WHO 2011 Model List and some Chinese provincial lists included both primary care and hospital medicines. WHO Model List includes both form and dosage for a molecule while China EMLs only include form.

Recommendations for the China EMLs are: to adapt more transparent and evidence based methods for EM selection, develop tiered NEML with different levels of care, critically review molecules found to be different between the WHO 2011 Model and China EMLs, add dosage information for molecules in China EMLs and align sections of the China EMLs according to the WHO framework and to the ATC system for more manageable monitoring and evaluation.

 
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