Health Technology Assessment in Developing the National List of Essential Medicines in Thailand
* Chairman of the Subcommittee for Development of the National List of Essential Medicines BE 2555-2558
Affiliation : Visanu Thamlikitkul MD*
The National List of Essential Medicines (NLEM) is developed in order to include the medicines that are necessary for the health needs of the Thai population. The NLEM is designed to be an “optimum list” and it is intended to be a mechanism that supports and promotes rational use of medicines for all stakeholders. It is also a reference for pharmaceutical benefits under major health insurance schemes i.e. Social Security Scheme, Civil Servant Medical Benefit Scheme and Universal Coverage Scheme. The main principle for developing the NLEM is that each medicine to be included in the NLEM must show evidence of its efficacy/effectiveness, its benefits outweighs its risks, its efficiency (cost-effectiveness), and its budget impact is affordable. Therefore, there are three steps in the selection of the medicines to be included in the NLEM. Step 1 is to assess efficacy/effectiveness and safety of the proposed medicine. Step 2 is to assess efficiency (cost-effectiveness) of the medicine that is shown to be efficacious/effective and safe. Step 3 is to estimate the amount of needed resources if the cost-effective medicine is included in the NLEM in order to determine its affordability by the administrators of the aforementioned major health insurance schemes. All information of the three steps is submitted to the chairman of the National Drug System Development Committee who then will make a decision whether the medicine should be included in the NLEM. The efficiency (cost-effectiveness) of the medicine that is shown to be efficacious/effective and safe has been explicitly assessed based on the guidelines of a health technology assessment (HTA) developed by a group of national experts and endorsed by the Subcommittee for Development of the NLEM since 2008. The Guidelines for Health Technology Assessment in Thailand were revised in 2013 to include several important issues (such as the guidelines on budget impact analysis, social and ethical impact assessment) that were not discussed the first thai HTA guidelines. Many up-to-date methodological issues are also included in the Guidelines for Health Technology Assessment in Thailand (Second Edition). The Guidelines for Health Technology Assessment in Thailand (Second Edition) have been approved by the Subcommittee for Development of the NLEM and they will be used for conducting health economic evaluations and budget impact analyses to consider if the medicine is cost-effective and affordable, and whether it should be finally included in the NLEM.
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