Comparative analysis of the composition of the official lists of medicines in Brazil, Costa Rica and Mexico during 2010 and 2015

Abstract

Objective. To analyze the quantity and composition of the 2010 and 2015 official lists of medicines of Brazil, Costa Rica and Mexico contrasting them with the WHO list in order to produce useful information to support decision-making in public health and users that may be interested in the subject. Material and methods. Observational and retrospective study that used information from secondary sources of free access. We classified the medicines according to the ATC codification up to the 2nd level. We analyzed the number and groups of medicines and estimated the absolute and relative frequencies for certain therapeutic groups. We carried out proportions differences tests (proportions test) to assess the variabilities in the composition of four anti-infective therapeutic groups and ten chronic disease care groups which were compared with their counterpart of the WHO Model List of Essential Medicines (MLEM-WHO). We generated a benchmarking on the selection process. Results. Between 2010 and 2015 the Brazilian list (RENAME-Brazil) increased 22% (378 to 473 groups ATC 2nd level), the Mexican list (CByCM-Mexico) increased 6% (872 to 924 groups), and the Costa Rican list (LOM-CR) had a 2% reduction. In both years, the total of ATC medicines 2nd level of the MLEM-WHO, was less compared to Brazil, Costa Rica and Mexico (MLEM-WHO 2010, 360 groups; 2015, 426 groups). Among the anti-infections medicines that were compared, the largest number corresponded to medicines for systemic infections of bacterial origin (J01), medicines for systemic infections caused by viruses (J05). Among medicines for chronic diseases, antineoplastic drugs (L01, L04) were predominant. In 2015, we observed differences in the proportions of J01 and J05 LOM-CR, J05 CByCM-Mexico, and L01 RENAME-Brazil (proportions< MLEM-WHO; p<0.05); contrasting with L04 (RENAME-Brazil and CByCM-Mexico) (proportions> MLEM-WHO). The three countries have public institutions that are responsible for updating the lists. We found more similarities than differences in their guidelines. Conclusions. There are some similarities in the types of medicines groups included in the lists of the three countries, but there are large variations in the number of medicines included in the lists, specifically in the Mexican list in contrast with the MLEM-WHO.