title: Cost-analysis of the WHO Essential Medicines List in A Resource-Limited Setting: Experience from A District Hospital in India.
abstract: The World Health Organization (WHO) has been publishing the essential medicines list (EML) since 1977. The EML includes the most efficacious, safe and cost-effective drugs for the most relevant public health conditions worldwide. The WHO performs a cost-effectiveness analysis within each therapeutic group, but very little is known about which therapeutic groups are costliest for hospitals that adopt the WHO EML concept. In this study, we have described the annual consumption of medicines in a district hospital in India, that limited the list of available drugs according to the WHO EML concept. Only 21 drugs constituted 50% of the hospital spending. Anti-infective medicines accounted for 41% of drug spending, especially antiretrovirals which were used to treat HIV infection. Among other therapeutic groups, insulin had the highest impact on the hospital budget. We identified medicines used in perinatal care, which included anti-D immunoglobulin and lung surfactants, that were used rarely, but bore a relatively high cost burden. The results of this study indicate that, in district that adopt the WHO EML, antiretrovirals and antibiotics were the top therapeutic groups for the drug hospital budgets.
authors.affiliation: Consultant, Department of Medicine, Rural Development Trust Hospital , Bathalapalli, AP, India .
authors.forename: Gerardo
authors.initials: G
authors.lastname: Alvarez-Uria
authors.affiliation: Professor, Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education & Research , Anantapur, AP, India .
authors.forename: Dixon
authors.initials: D
authors.lastname: Thomas
authors.affiliation: Associate Professor, Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education & Research , Anantapur, AP, India .
authors.forename: Seeba
authors.initials: S
authors.lastname: Zachariah
authors.affiliation: Student, Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education & Research , Anantapur, AP, India .
authors.forename: Rajarajeshwari
authors.initials: R
authors.lastname: Byram
authors.affiliation: Consultant, Department of Anaesthesia, Rural Development Trust Hospital , Bathalapalli, AP, India .
authors.forename: Shanmugamari
authors.initials: S
authors.lastname: Kannan
keywords: Anti-infective agents; Budgets; Cost and cost-analysis; Essential drugs; World Health Organization