Article
Cochrane systematic reviews for the use of international guideline information to improve worldwide cancer care: experience report on how to inform the WHO Essential medicines list
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Authors
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Vanessa Piechotta
- Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Abteilung I für Innere Medizin, Centrum für integrierte Onkologie Aachen Bonn Köln Düsseldorf, Cochrane Haematological Malignancies, Köln, Deutschland
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Marius Goldkuhle
- Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Abteilung I für Innere Medizin, Centrum für integrierte Onkologie Aachen Bonn Köln Düsseldorf, Cochrane Haematological Malignancies, Köln, Deutschland
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Nicole Skoetz
- Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Abteilung I für Innere Medizin, Centrum für integrierte Onkologie Aachen Bonn Köln Düsseldorf, Cochrane Cancer, Köln, Deutschland
| Published: | February 12, 2020 |
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Outline
Text
Background/research question: Essential medicines aim to satisfy the priority health needs of a population. They are meant to be safe and effective, as well as universally available and affordable. The World Health Organizations Essential Medicines List (EML) provides an evidence-based model upon which countries can base their own essential medicine or reimbursement lists. An expert committee assembles biennially in order to revise and update the EML, based on the latest evidence. Scientists and stakeholders worldwide are requested to prepare applications for the inclusion of novel medicines, and changes to or deletion of currently listed items.
Aim: To illustrate the process and impact of Cochrane systematic reviews for EML applications.
Methods: As part of a prioritisation within the Cochrane Cancer network, we identified a lack of anti-myeloma medicines in the EML. In case inadequacies are identified, an application for the revision of the EML can be prepared. There are three possible scenarios to integrate Cochrane evidence into EML applications:
- 1.
- An up-to-date Cochrane Review provides sufficient information to inform the evidence body of an EML application
- 2.
- An up-to-date Cochrane review provides not all of the necessary information, however it can be complemented with the additionally necessary information
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- There is no (up-to-date) Cochrane review, however an author team is keen to take on the prioritised research question
Results: As there was no Cochrane review to this time, we formed an author team to conduct a rapid network meta-analysis to compare multiple drugs for initial treatment of myeloma patients [1]. Subsequently, we made contact to the WHOs EML secretariat to discuss a possible EML application for anti-myeloma medicines. Based on the results of this evidence synthesis, we prepared an application for the inclusion of three individual medicines (bortezomib, lenalidomide, and thalidomide) into the EML [2]. Following the 22nd WHO expert committee held in April 2019, all of our proposed medicines have been included into the latest version of the EML: https://apps.who.int/iris/bitstream/handle/10665/325771/WHO-MVP-EMP-IAU-2019.06-eng.pdf?ua=1
Conclusion: The evidence-based identification of highly effective and priority medicines can help healthcare decision-makers to meet regional, and global health targets. Integrating systematic Cochrane evidence into EML applications results in an adequate consideration of potential biases, uncertainties, and supports the identification of the best treatment options.
Competing interests: none
References
- 1.
- Piechotta V, Jakob T, et al. Multiple drug combinations of bortezomib, lenalidomide, and thalidomide for first-line treatment in adults with transplant-ineligible multiple myeloma: a rapid review and network meta-analysis. Cochrane Database of Systematic Reviews. In press.
- 2.
- Piechotta V, Goldkuhle M, Scheid C, Skoetz N. Proposal for the Inclusion of Bortezomib, Lenalidomide and Thalidomide in the WHO Model List of Essential Medicines for the First-Line Treatment of Multiple Myeloma. In: 22nd WHO Expert Committee for the Essential medicines selection. Medicines for multiple myeloma EML. 2019. Available from: https://www.who.int/selection_medicines/committees/expert/22/applications/myeloma/en/
