title: The evolution of Reference Drug Lists and Clinical Practice Guidelines in the public health system of a middle-income country.
abstract: OBJECTIVE
  The aims were to analyze the dynamics of the medicines formulary in a middle-income country and to analyze the concordance of the included medicines with the national Clinical Practices Guidelines (CPG).
  
  
  METHODS
  Medicines and their indications of use included in the Mexican Reference Drug List (Mex-RDL) from 1996 to 2013 were analyzed. The top 10 indications with the highest number of medicines in 2013 were analyzed retrospectively until 1996 in order to identify the increase in the number of medicines to treat each one, as well as the progressive specificity of the indication according to the International statistical Classification of Diseases (ICD-10). The concordance between the CPG and medicines approved for the top 10 indications was studied.
  
  
  RESULTS
  The number of medicines included in the Mex-RDL kept constantly growing from 454 drugs in 1996 to 811 in 2013. Up to 26.3% of these medicines were approved to treat only 10 indications (1.5% of all possible indications of use). Many of these new medicines had been approved for more and more specific indications, while the oldest ones had been approved for general indications. Up to 27.6% of the medicines approved for these top 10 indications do not appear in the updated recommendations of the specific CPG for those indications.
  
  
  CONCLUSIONS
  During the last 18 years, the new medicines and indications included in the Mex-RDL were redundant and concentrated into few similar clinical conditions. This is a factor that promotes an irrational use of these medicines and, thus, unnecessarily raises the price of health care, undermines the quality of the health system and probably increases the uncertainty of treatments.
authors.affiliation: Health Sciences School, University of the Valley of Mexico, Mexico City, Mexico; Departament de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona, Barcelona.
authors.forename: Israel
authors.initials: I
authors.lastname: Rico-Alba
authors.forename: Albert
authors.initials: A
authors.lastname: Figueras
mesh_terms: D003362:Cost-Benefit Analysis; D003906:Developing Countries; D016527:Drug Costs / Q000331:legislation & jurisprudence; D004358:Drug Therapy / Q000191:economics / Q000592:standards* / Q000639:trends; D017723:Drug Utilization Review / Q000706:statistics & numerical data / Q000639:trends; D018954:Drugs, Essential / Q000145:classification / Q000191:economics / Q000600:supply & distribution*; D019317:Evidence-Based Medicine; D005569:Formularies as Topic; D040541:Marketing / Q000706:statistics & numerical data; D008800:Mexico; D017410:Practice Guidelines as Topic; D011634:Public Health / Q000592:standards* / Q000639:trends
chemical_list: D018954:Drugs, Essential
keywords: Mexico; drug utilization study; marketing strategies; medicines indications of use; rational use of medicines
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