25國基本藥物目錄循證評價_《中國循證醫學雜志》

作者：

王莉 ¹ , 周幫旻 ¹ , 宋佳佳 ² , 彭靜 ² , 袁強 ¹ , 許曉波 ² ,  李幼平 ¹

1. 四川大學華西醫院中國循證醫學中心（成都?610041）；2. 四川大學華西臨床醫學院（成都?610041）;

關鍵詞：

基本藥物目錄合理用藥藥物遴選標準標準治療指南循證評價

DOI：

10.7507/1672-2531.20090133

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目的　系統比較25國已有國家基本藥物目錄(EML)，為我國制定EML和建立配套保障制度提供決策參考。
方法　檢索各國衛生部和藥品監督管理機構的官方網站，系統收集正式頒布的EML。兩名評價員獨立篩選文獻、提取資料。通過描述性分析比較各國EML的制定時間、更新周期、遴選委員會組成、遴選標準、藥品類別劃分標準、品種數、藥品信息和配套標準治療指南的情況。
結果　截至2009年5月，共檢索納入25國36個版次的國家EML，其中英文34個、中文2個。25國從1982～2009年開始出版國家EML，更新周期4個月~8年。參與制定EML的部門包括：中央政府、衛生或藥品監督管理、公共衛生、基本藥物、教育培訓等部門。藥物遴選委員會包括：臨床醫學、衛生行政管理、藥學（藥理學）、高等醫學教育、經濟學、統計和流行病學、國際組織專家（WHO或UNICEF）、財政、病人代表、制藥業等領域的專家。各國普遍依據WHO對基本藥物的定義和遴選標準，結合本國國情制定了基于藥品安全、有效和經濟性的科學證據、兼顧疾病負擔和藥品合理使用及生產供應等方面的遴選標準。EML納入藥品數在103～2 033種，中位數為447種：最多為中國，2033種，其中西藥773種、中藥1 260種；最少的是索馬里103種。藥品分類借鑒WHO解剖-治療-化學代碼（ATC法），藥品信息包括通用名、劑量、劑型和給藥途徑。各國按醫療機構級別、醫生的執業職稱及執業范圍分級配置和使用EML。配套的標準治療指南或處方集覆蓋73～163種疾病，主要包括疾病的診斷、治療方法的選擇、合理用藥、禁忌癥和藥品不良反應等內容。
結論　由于各國經濟、文化、疾病負擔和醫療衛生服務發展水平不同，各國基本藥物目錄差異較大。在基本藥物遴選與使用、標準治療指南制定、配套制度等方面，澳大利亞、南非等國都有較好的經驗值得借鑒。建議建立我國基本藥物決策管理體系，制定覆蓋我國主要疾病負擔，針對常見病、多發疾病的基層醫療機構基本藥物目錄。

引用本文： 王莉,周幫旻,宋佳佳,彭靜,袁強,許曉波,李幼平. 25國基本藥物目錄循證評價. 中國循證醫學雜志, 2009, 09(7): 754-764. doi: 10.7507/1672-2531.20090133 復制

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1. File/PBAC4.3.2(01DEC08).pdf.
2. 中共中央、國務院. 關于深化醫藥衛生體制改革的意見. 2009年3月17日available from:URL: http://www.gov.cn/jrzg/2009-04/06/content_1278721.htm.
3. 令狐昌黎, 楊悅. 我國《基本藥物目錄》與世界衛生組織《基本藥物目錄》比較研究. 中國藥房, 2009, 20(02): 83-86.
4. 任靜, 宋大平, 趙東暉, 等. 新型農村合作醫療基本藥物目錄制定現狀分析. 中國衛生經濟, 2009, 28(05): 66-68.
5. Australian Government, Department of Health and Ageing and Medicare Australia. Schedule of Pharmaceutical Benefits.Availianle from:URL:http://www.pbs.gov.au/html/home.
6. The National Drugs List Of Syrian Arab Republic, Fifth Edition.
7. National Essential Drug List (NEDL) of Malaysia 2nd Edition. September 2008.
8. STANDARD TREATMENT GUIDELINES AND ESSENTIAL DRUGS LIST FOR SOUTH AFRICA. Available from:URL: http://www.doh.gov.za/docs/factsheets/.
9. Essential Drugs and Medicines of Kingdom of Thailand,. Available from:URL: http://www.searo.who.int/LinkFiles/Essential_Drugs_and_Medicines_THA.pdf.
10. REPUBLICA DEMOCRATICA DE TIMOR LESTE (RDTL), MINISTERIO DA SAUDE. Essential Medicines List for East Timor Complete List 2nd Issue. August 2004.
11. Ministry of Health & Population, Technical Research and Training Department (TRTD), Central Administration of Pharmaceutical Affairs (CAPA). National essential drug list & guidelines (Egypt). 2006.
12. Maldives Essential Medicines List 2008. Available from:URL: http://www.searo.who.int/LinkFiles/Essential_Drugs_and_Medicines_MAV.pdf.
13. 中國國家基本藥物2004版. Available from:URL:Http//www.sfda.org.cn.
14. Bhutan.Essential Drugs List 2009.
15. Model List of Essential Drugs of Georgia (WHO) 2007. Available from: URL: http://www.humanitarianreform.org/humanitarianreform/Portals/1/cluster%20approach%20page/clusters%20pages/health%20cluster/Georgia/2008_Aug_25_EssentialDruglistinGeorgian%20(2).doc.
16. Government of Democratic Socialist Republic of Sri Lanka, Ministry of Healthcare and Nutrition, LIST OF ESSENTIAL MEDICINES.
17. Department Of Health Philippines. Essential Drug List. Available from: URL: http://doh.gov.ph/ndps/EssentialDrugsList.htm.
18. MINISTRY of HEALTH REPUBLIC of INDONESIA National List of Essential Medicines 2008.
19. Directorate General of Health Services, Ministry of Health & Family Welfare Government of India. National List of Essential Medicines 2003.
20. Ministry of Health Government of Pakistan Islamabad.NATIONAL ESSENTIAL DRUGS LIST OF PAKISTAN 2003.
21. MINISTRY OF HEALTH & SOCIAL WELFARE.STANDARD TREATMENT UIDELINES AND ESSENTIAL MEDICINES LIST FOR LESOTHO 2005.
22. Ministry of Health of Sudan. NATIONAL LIST OF ESSENTIAL MEDICINES 2005.
23. National Essential Drug List of Cambodia, December 2002.
24. REPUBLIC OF GHANA, Ministry of Health.GHA NA ESSENTIAL MEDICIN ES LIST Fifth Edition 2004.
25. Ministry of Health & Family Welfare Public Health-1 Branch，Bangladesh. LIST OF ESSENTIAL DRUGS. April 8, 2008.
26. Government of Nepal, MINISTRY OF HEALTH AND POPULATION, DEPARTMENT OF DRUG ADMINISTRATION. NATIONAL LIST OF ESSENTIAL MEDICINES NEPAL (Fourth Revision) 2009.
27. Islamic Republic of Afghanistan, Ministry of Public Health General, Directorate of Pharmacy , Avicenna Pharmaceutical Institute, Essential Drugs Department. National Essential Drugs List. December 2007.
28. Somalia Standard Treatment Guidelines and Training Manual on Rational Management and Use of Medicines at the Primary Health Care Level (Second edition). WHO-EM/EDB/073/E. 2007.
29. Essential Drugs and Medicines of Union Of Myanmar. Available from:URL: http://www.searo.who.int/LinkFiles/Essential_Drugs_and_Medicines_MMR.pdf.
30. Guidelines for preparing submissions to the Pharmaceutical Benefits Advisory Committee (Version 4.3) Available from:URL: http://www.health.gov.au/internet/main/publishing.nsf/Content/AECB791C29482920CA25724400188EDB/.
31. 王青, 蘭奮, 肖愛麗, 等. 推廣基本藥物, 人人享有基本藥物——紀念基本藥物概念誕生25周年. 藥物流行病學, 2003, 12(2): 57-59.
32. . 孟銳, 李穎. 國家基本藥物遴選與藥物經濟學. 中國藥房, 2007, 18(35): 2721-2723.
33. . 葉露. 國家基本藥物政策研究. 2008年3月. 中國博士學位論文全文數據庫.

《中國循證醫學雜志》

25國基本藥物目錄循證評價

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《中國循證醫學雜志》

25國基本藥物目錄循證評價

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