Effect on mortality of inclusion of drugs in Thailand's National List of Essential Medicines, 2005–2016

Abstract

ObjectiveTo assess the effect of long-run changes in the drugs included in the National List of Essential Medicines (NLEM) on mortality in Thailand. MethodsUsing longitudinal data on many diseases, I estimate difference-in-differences (2-way fixed effects) models to investigate whether diseases for which there were larger increases in the number of NLEM drugs had larger subsequent reductions (or smaller increases) in mortality. This design controls for the effects on mortality of general economic and societal factors (e.g. income, education, and behavioral risk factors), to the extent that those effects are similar across diseases. ResultsThe addition of drugs to the NLEM between 2003 and 2014 reduced the number of years of potential life lost before age 75 in 2016 by about 650 thousand. The addition of a new (post-2002) drug for a disease to the NLEM is estimated to have reduced the number of deaths from that disease two years later by 25%, while the addition of an old (pre-2003) drug is estimated to have reduced the number of deaths two years later by 5%. ConclusionThe expansion of the NLEM reduced the number of deaths and the number of years of potential life lost before ages 75 and 65 2–5 years later. A preliminary estimate of pharmaceutical expenditure per life-year before age 75 gained in 2016 from drugs added to the NLEM between 2003 and 2014 is 888 USD.