Essential medicines concept and health technology assessment approaches to prioritising medicines: selection versus incorporation

Growing expenditure on medicines is impacting the sustainability of health systems. The global pharmaceutical market is estimated to grow at a rate of 3–6% annually through 2027, surpassing US$1.9 trillion by 2023. An average of 65 new drugs are expected to be launched per year, primarily oncology, immunological, anti-diabetic, and obesity drugs, resulting from a continuous stream of innovative products. Medicines are also the biggest driver of out-of-pocket payments (OOPs) and catastrophic health expenditure globally, with spending on medicines creating a greater financial burden for households than spending on inpatient or outpatient services. On the one hand, overdiagnosis, inappropriate prescribing and medicine use may lead to over-treatment, inappropriate treatment, and health hazards. On the other hand, lack of access to affordable medicines is a significant barrier to accessing health care.

In this commentary, we look at two paradigmatic approaches to prioritising medicines for use in health systems—the Essential Medicines concept, upon which the process of selecting essential medicines is based, and Health Technology Assessment, which is the process for comparing individual medicines using an aggregate of analytical tools, mainly involving cost-effectiveness. The paper intends to highlight gaps in research and lack of evidence for these approaches mainly on their effectiveness in containing costs, ensuring access and appropriate medicine use.