Agrawal Disha, Shrinivas Divya, Sharma Parth, Rajagopal Muttacaud Ramakrishnan, Ghoshal Arun, Zadey Siddhesh
Association for Socially Applicable Research (ASAR), Pune 411007, Maharashtra, India.
Maulana Azad Medical College, New Delhi 110002, India.
Ecancermedicalscience. 2025 Feb 5;19:1837. doi: 10.3332/ecancer.2025.1837. eCollection 2025.
Essential medicines lists (EMLs) guide the public sector procurement and supply of medications to impact access to adequate and appropriate palliative care drugs. This study evaluates the adequacy of India's national and sub-national EMLs that can directly impact palliative care for 5.4 million patients.
In this qualitative document review, we compared Indian national, and state EMLs acquired from official government websites with the International Association for Hospice and Palliative Care (IAHPC) EML recommendations. We analysed data on the indication and formulation of drugs under the different categories of formulations present (all, some and no), and drugs absent. Literature review and inputs from palliative care experts provided alternatives of absent medications to assess the adequacy of lists in managing the symptoms listed by IAPHC.
We analysed 3 national and 27 state lists for 33 recommended drugs. The Central Government Health Services list had the maximum availability of all formulations of drugs (16 [48%]) nationally. Among states and union territories, the Delhi EML was the closest to IAHPC with 17 (52%) drugs with all formulations present. Karnataka had the most incomplete EML with only 3 (9%) drugs with all formulations present. No EML had all the recommended formulations of morphine. In one national and seventeen state EMLs, oral morphine was absent.
While Indian EMLs lack drugs for palliative care when compared with the IAHPC EML, symptom management is adequate. There is a need for countries with limited resources to modify the IAPHC list for their settings.
基本药物清单指导公共部门的药品采购和供应，以影响获得充足且合适的姑息治疗药物的机会。本研究评估了印度国家和次国家级基本药物清单的充足性，这些清单可直接影响540万患者的姑息治疗。
在这项定性文件审查中，我们将从官方政府网站获取的印度国家和邦基本药物清单与国际临终关怀与姑息治疗协会（IAHPC）的基本药物清单建议进行了比较。我们分析了现有不同剂型类别（全部、部分和无）下药物的适应症和剂型数据，以及缺失的药物。文献综述和姑息治疗专家的意见提供了缺失药物的替代药物，以评估清单在管理IAHPC列出的症状方面的充足性。
我们分析了3份国家级和27份邦级清单中的33种推荐药物。中央政府卫生服务清单在全国范围内所有剂型的药物可用性最高（16种[48%]）。在各邦和联邦属地中，德里的基本药物清单最接近IAHPC，有17种（52%）药物所有剂型都有。卡纳塔克邦的基本药物清单最不完整，只有3种（9%）药物所有剂型都有。没有基本药物清单包含吗啡的所有推荐剂型。在1份国家级和17份邦级基本药物清单中，口服吗啡缺失。
与IAHPC基本药物清单相比，印度基本药物清单缺乏姑息治疗药物，但症状管理是足够的。资源有限的国家有必要根据自身情况修改IAHPC清单。
