Effects of Listing
and Delisting in
National Essential
Medicine List on
Utilization Patterns
Sauwakon Ratanawijitrasin, PhD and
Sanita Hirunrassamee, PhD
Background
pharmacological
category
Lipid-regulating
drugs
Dugs affecting the
renin-angiotensin
system
Drugs used in the
control of epilepsy
Generic
NEML
2004
2008
Simvastatin


Atorvastatin


Rosuvastatin


Enalapril maleate


Losartan potassium


Valsartan


Sodium valproate


Topiramate


Levitriacetam


Gabapentin


Pregabapentin


Objective
To examine the effects of NEML listing
and delisting on the utilization
patterns comparing:
 Delisted drugs with remaining or Added
medicines
 “non-essential” medicines (NEM- not listed in
both NEML editions) in the same
pharmacological category
NEML: National Essential Medicine List
Methodology
3 groups of
Medicine
1. Statins
2. ACEIs
3. Antiepileptics
OPD
e-dispensing
databases
9
government
hospitals
Statistics
Segmented
Regression
Analysis of
interrupted
time series
data
Data Source: Dispensing data collected for "Data management for systematic monitoring of drug
utilization and policy project"--a collaboration between IMRTA and PharReD Foundation.
Methodology (cont.)
14 mo
Before
2008
10 mo
NEML
After
24 months time-series data points
Methodology (cont.)
Comparison
•Statins - 130,287 pt
•ACEIs & AIIAs - 85,349 pt
•Anti-epileptics 31,739 pt
3 major health
insurance schemes
•CSMBS
•SSS
•UC
RESULTS
Utilization Patterns across Health Insurance Scheme
Conclusion
NS
No statistical significant changes in the
utilization patterns of the listed, delisted and
non-listed medicines occurred after the
introduction of the 2008 NEML
Sig .
Discrepancies in utilization were
found among patients in different
health insurance systems.
Ans.
It appears that health insurance policy
exerts greater influence on utilization
patterns than essential medicine
policy.
Acknowledgement: Institute of Medical Research Technology Assessment (IMRTA) and
Pharmaceutical System Research & Development Foundation (PharReD Foundation)