Essential Medicines List and Health Technology Assessment. Two complementary strategies to prioritize medicines in health systems

Abstract

This article describes two strategies for incorporating medicines into national health coverage programs: the use of the WHO Essential Medicines List (EML) as a model for National Medicines Lists, and the implementation of Health Technology Assessment (HTA). We also put forward the main challenges that countries face, both in normal situations, as well as under financially restrictive conditions or during health or environmental emergencies Historically, high-income countries have used the HTA as a tool for incorporating medicines into their healthcare system, and low- and middle-income countries (LMIC) have followed the WHO EML. However, in recent years we have observed an increase in the use of HTAs in LMIC as well as the use of EMLs under special circumstances in high-income countries. Although both strategies partially share their basic methodological core, they differ in the procedure of selecting health problem, in using modeling procedure for economic assessment and in their final outcomes. The goal of this article is to evaluate the validity of the concept of essential medicines (EM) in times of increasing use of the HTA, and the need for relying on both strategies when making evidence-based healthcare decisions.