尼泊尔基本姑息治疗药物的可及性和可负担性：一项横断面研究。
Availability and Affordability of Essential Palliative Care Medicines in Nepal: A Cross-Sectional Study.
机构信息
INF Nepal Green Pastures Hospital and Rehabilitation Centre (R.S., B.H., D.M.), Pokhara, Nepal.
INF Nepal Green Pastures Hospital and Rehabilitation Centre (R.S., B.H., D.M.), Pokhara, Nepal.
出版信息
J Pain Symptom Manage. 2024 Jul;68(1):61-68. doi: 10.1016/j.jpainsymman.2024.03.026. Epub 2024 Apr 4.
CONTEXT
The government of Nepal adopted the 2017 Nepalese National Strategy for Palliative Care (NSPC), which proposed that Essential Palliative Care Medicines (EPCMs) listed by the International Association for Hospice and Palliative Care (IAHPC) should be available at each healthcare institution. In 2017 after the issuing of NSPC, the Lancet Commission developed an EPCM list.
OBJECTIVES
To evaluate the inclusion of EPCMs recommended by both IAHPC and Lancet in national medicinal programmes, their availability, and affordability in Nepal.
METHODS
A cross-sectional descriptive study of the availability of EPCMs in Nepal, and their inclusion in the national essential medicines list, government health insurance medicines list, government fixed rate medicines list, and free medicines list. Affordability was assessed using the World Health Organization Daily-Define-Dose and the Nepal Government-defined minimum daily wage.
RESULTS
A total of 27 of 33 (82%) of the IAHPC-EPCMs and 41 of 60 (68%) of the recommended formulations were available in Nepal. All the Lancet Commission recommended EPCMs were available in Nepal. Morphine was available in all formulations used in palliative care. 22%, 18%, and 10% of IAHPC-EPCMs were available cost-free via district hospitals, primary healthcare centers, and health posts, respectively. The government had not included opioids on both free and fixed price lists. A total of 24 of 33 (73%) IAHPC-EPCMs were available on the Government Health Insurance Medicines List. A total of 19 of 41 (46%) available EPCMs were affordable.
CONCLUSION
Many EPCM formulations included in NSPC of Nepal are not available, and most available EPCMs are unaffordable if purchased out-of-pocket. While the availability is better with the government health insurance scheme, many people are not registered for this. Further improvements should follow the development of a Nepalese palliative care formulary.
背景
尼泊尔政府通过了 2017 年尼泊尔国家姑息治疗战略（NSPC），该战略提出，国际姑息治疗协会（IAHPC）列出的基本姑息治疗药物（EPCM）应在每个医疗机构提供。在 2017 年 NSPC 发布后，柳叶刀委员会制定了 EPCM 清单。
目的
评估 IAHPCEPCM 和柳叶刀委员会推荐的 EPCM 在尼泊尔国家药物方案中的纳入情况、可及性和可负担性。
方法
对尼泊尔 EPCM 的可及性及其在国家基本药物清单、政府医疗保险药品清单、政府固定价格药品清单和免费药品清单中的纳入情况进行横断面描述性研究。使用世界卫生组织每日定义剂量和尼泊尔政府定义的最低工资来评估可负担性。
结果
IAHPC-EPCM 中有 27/33（82%）和推荐配方中有 41/60（68%）在尼泊尔可用。柳叶刀委员会推荐的所有 EPCM 都在尼泊尔可用。吗啡在姑息治疗中使用的所有配方中都有。22%、18%和 10%的 IAHPC-EPCM 通过区医院、初级保健中心和卫生所免费提供。政府在免费和固定价格清单上都没有包括阿片类药物。33 种 IAHPC-EPCM 中有 24 种（73%）列入政府医疗保险药品清单。可用的 41 种 EPCM 中有 19 种（46%）可以负担得起。
结论
尼泊尔 NSPC 中包含的许多 EPCM 配方不可用，如果自费购买，大多数可用的 EPCM 都无法负担。虽然政府医疗保险计划的供应情况较好，但许多人没有注册该计划。在制定尼泊尔姑息治疗配方后，应进一步改进。
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