WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation; Department of Neuroscience, Biomedicine and Movement Sciences; Section of Psychiatry, University of Verona, Verona, Italy.
Cochrane Global Mental Health, University of Verona, Verona, Italy.
Epidemiol Psychiatr Sci. 2022 Apr 19;31:e22. doi: 10.1017/S2045796022000087.
To provide a cross-country analysis of selection, availability, prices and affordability of essential medicines for mental health conditions, aiming to identify areas for improvement.
We used the World Health Organization (WHO) online repository of national essential medicines lists (EMLs) to extract information on the inclusion of essential psychotropic medicines within each country's EML. Data on psychotropic medicine availability, price and affordability were obtained from the Health Action International global database. Additional information on country availability, prices and affordability of essential medicines for mental disorders was identified by searching, up to January 2021, PubMed/Medline, CINAHIL, Scopus and the WHO Regional Databases. We summarised and compared the indicators across lowest-price generic and originator brand medicines in the public and private sectors, and by country income groups.
A total of 112 national EMLs were analysed, and data on psychotropic medicine availability, price and affordability were obtained from 87 surveys. While some WHO essential psychotropic medicines, such as chlorpromazine, haloperidol, amitriptyline, carbamazepine and diazepam, were selected by most national lists, irrespective of the country income level, other essential medicines, such as risperidone or clozapine, were included by most national lists in high-income countries, but only by a minority of lists in low-income countries. Up to 40% of low-income countries did not include medicines that have been in the WHO list for decades, such as long-acting fluphenazine, lithium carbonate and clomipramine. The availability of generic and originator psychotropic medicines in the public sector was below 50% for all medicines, with low-income countries showing rates lower than the overall average. Analysis of price data revealed that procurement prices were lower than patient prices in the public sector, and medicines in the private sector were associated with the highest prices. In low-income countries, the average patient price for amitriptyline and fluoxetine was three times the international unit reference price, while the average patient price for diazepam was ten times the international unit reference price. Affordability was higher in the public than the private sector, and in high-income than low-income countries.
Access to medicines for mental health conditions is an ongoing challenge for health systems worldwide, and no countries can claim to be fully aligned with the general principle of providing full access to essential psychotropic medicines. Low availability and high costs are major barriers to the use of and adherence to essential psychotropic medicines, particularly in low-and middle-income countries.
对精神卫生条件基本药物的选择、可及性、价格和可负担性进行跨国分析，旨在确定需要改进的领域。
我们使用世界卫生组织（WHO）国家基本药物清单（EML）在线存储库，以提取每个国家 EML 中包含的基本精神药物信息。关于精神药物可及性、价格和可负担性的数据来自国际健康行动数据库。通过搜索，截至 2021 年 1 月，在 PubMed/Medline、CINAHIL、Scopus 和世卫组织区域数据库中获取了有关精神障碍基本药物在国家可用性、价格和可负担性的其他信息。我们总结并比较了公共和私营部门中最低价格通用药物和原研品牌药物以及国家收入组的指标。
共分析了 112 份国家 EML，并从 87 项调查中获得了精神药物可及性、价格和可负担性的数据。虽然一些世界卫生组织基本精神药物，如氯丙嗪、氟哌啶醇、阿米替林、卡马西平和地西泮，被大多数国家的清单所选择，无论国家的收入水平如何，但其他一些基本药物，如利培酮或氯氮平，被大多数高收入国家的国家清单所选择，但只有少数低收入国家的清单所选择。多达 40%的低收入国家没有包括几十年来一直列入世界卫生组织清单的药物，如长效氟奋乃静、碳酸锂和氯米帕明。公共部门中通用和原研精神药物的可及性低于所有药物的 50%，低收入国家的这一比例低于总体平均水平。价格分析显示，采购价格低于公共部门的患者价格，而私营部门的药物价格最高。在低收入国家，阿米替林和氟西汀的患者平均价格是国际单位参考价格的三倍，而地西泮的患者平均价格是国际单位参考价格的十倍。公共部门的可负担性高于私营部门，高收入国家高于低收入国家。
全世界的卫生系统在获得精神卫生条件药物方面仍然面临挑战，没有任何国家可以声称完全符合提供基本精神药物全面可及的一般原则。可及性低和费用高是使用和坚持基本精神药物的主要障碍，特别是在中低收入国家。
