Building the Case for Clopidogrel as a World Health Organization Essential Medicine.

Abstract

The World Health Organization (WHO) defines essential medicines as medicines that satisfy the priority healthcare needs of the population.1 These medicines are selected by the WHO based on their public health relevance, international availability, treatment details, efficacy and safety, comparative cost-effectiveness, the need for special requirements or training needed for the safe/appropriate use of the medicine, and regulatory status.1 The medicines that are considered highest priority are included on the WHO Model List of Essential Medicines or Essential Medicines List (EML). The EML was first published in 1977 and is revised every 2 years by an expert committee. It serves as a catalog of critical medicines and informs purchasing decisions of low- and middle-income country (LMIC) governments.1,2 Most individual nations align the WHO EML with the epidemiological profile and health priorities of their population to create a national EML.3 Medicines on the national EML are then subsidized by the public sector, making them more affordable to the general population.4 For example, in the national Mutuelle insurance system in Rwanda, members are eligible to receive national EML drugs for outpatient treatment with only a 10% copayment.3,5 In November 2012, the WHO announced its target to reduce the risk of premature mortality related to noncommunicable diseases by 25% by the year 2025.6 This goal is to be achieved, in part, through a health system target that assures availability of essential medicines and technologies to treat noncommunicable diseases, including cardiovascular disease (CVD), to at least 50% of eligible individuals. The 18th edition of the WHO EML includes several drugs for the treatment and control of acute and chronic CVDs, including aspirin, streptokinase, heparin, simvastatin, bisoprolol, and enalapril.7 However, clopidogrel, a thienopyridine often used in conjunction with aspirin as a second antiplatelet …