The Committee reviewed the experience with the original model list and the subsequent revisions, as well as the future needs of the model list. It concluded that the model list has played an important role in establishing and promoting the concept of essential drugs. The model list has been adopted and adapted globally. Both the methodology of the process for selecting drugs for inclusion in the list and the list itself serve as useful models. The Committee then reviewed how these two uses of the list could best be served in the future.
With regard to the process of selection of essential drugs, the Committee endorsed WHO’s efforts to link the selection of drugs on the model list to its guidelines for treatment and recommended that this approach be continued, to the extent possible, in order to facilitate the implementation of such guidelines. The Committee also expressed its support for WHO’s efforts to develop evidence-based guidelines for the treatment of diseases and recognized the value of this activity.
The Committee agreed that its decisions on whether to include drugs in the model list should be based on properly identified evidence. Proposals to include drugs in the model list submitted to the Committee should be better defined, and should include a valid analysis of the cost-effectiveness of each drug. The reasons for the Committee’s final decision should be carefully recorded.
With regard to the model list, the Committee concluded that the list should indicate priority conditions and drugs for which equitable availability and affordability should be ensured before re-sources are spent on other treatments. In addition to this core list, a special identification should indicate drugs that are cost-effective and safe, but which are not necessarily affordable and for which special training or health care services would be needed for their proper use.
The Committee also welcomed suggestions that the available evidence supporting the inclusion of drugs already on the model list be identified and made available, and agreed that a number of therapeutic groups would benefit from a general review. It was recognized that there are some drugs on the model list that are used to treat uncommon conditions, while drugs effective in treating other uncommon conditions are not included. The Committee was not able to identify the basis on which decisions to include or exclude drugs had been made, but noted that factors such as the frequency, severity and subjective perception of the importance of the condition and the efficacy of treatment had been used to varying degrees. The Committee decided that it was not appropriate to review this aspect of the list at the present meeting.
The Committee discussed the need for more explicit criteria for determining which diseases or conditions are appropriately included in the “health needs of the majority” and for which medication should be provided in the model list. Similarly, clearer descriptions are needed of the criteria for selecting drugs to be included in the model list. Recognizing the desirability of making the basis of its decision-making more transparent and taking into account recent technological advances in making clinical decisions such as the systematic reviews published by the Cochrane Collaboration, which are collectively referred to as evidence-based medicine, the Committee recommended that the methodology for its decision-making be reviewed as a matter of urgency. Following this review, a methodology for use by the Committee should be prepared, which should include a description of the process for submitting a proposal to include a drug in the model list. The Committee noted that resources would be required to implement these recommendations.