Why is there no triptan on the WHO's list of essential medicine?

Question

As a migraine sufferer myself I must admit, the existence of triptanes has made my life much better. If those would not exist, I might risk loosing my job if I have a bad phase of my migraines. So, for me, and for a lot of other people too, I guess, it is definitely essential.

By chance I just stumbled over the WHO's list of essential medicines on Wikipedia. It lists a lot of important medicine, as far as I understand, but also "duplicates" of medicines for the same conditions, but for migraine it only has standard pain medication (and a beta-blocker). Standard pain medication is like taking sugar pills for me during a real migraine. This does not sound like effective migraine medication.

I found this article stating that at least one triptan was planned to be included already in 2007. But obviously this did not happen.

The Committee also recommended that a full application for inclusion of a 5HT1 agonist (triptan) for migraine be submitted at its next meeting in 2007.

I don't want to demean other diseases, but as migraine is in fact listet as a condition, I would have expected at least one more migraine specific drug to be on the list. I would have been fine with the other mentioned drugs being listed as pain killers, but listing migraine and then not listing triptanes seems strange to me.

Why are there no triptanes in the list? Was there an official reason given for them not to be included?

Answer 1

The following is from the 2007 WHO Expert Committee meeting regarding the addition of sumitriptan:

The Committee noted that the application was generally of poor quality and provided only a limited review of the evidence. Although medicines for man- aging migraine are on the Model List, the information provided did not estab- lish the public health need for an additional medicine. As noted by the expert reviewers, there is high-quality clinical evidence from a Cochrane review (57) that supports the superiority of sumatriptan for the acute management of migraine, compared with placebo. However, there have been few trials com- paring sumatriptan with standard management (aspirin and metoclopramide, or caffeine and ergotamine). In these studies, sumatriptan was found to be superior in effectiveness to caffeine and ergotamine although it caused more adverse events. When compared with aspirin and metoclopramide, sumat- riptan was superior for only one outcome (pain relief at 2 hours) and also caused more adverse events. The Committee noted that it would be helpful to have updated Cochrane reviews to confirm these findings. Some studies have found that the 50 mg dose of sumatriptan is as effective as the 100 mg dose.

Despite the availability of some generic preparations, the current cost of sumatriptan is substantially higher than that of aspirin and metoclopramide. No valid cost-effectiveness evidence was provided.

Overall the evidence provided in the application did not support the public health need or comparative effectiveness, safety and cost-effectiveness of sumatriptan. The Committee therefore recommended that sumatriptan not be added to the Model List and will seek high-quality national treatment guidelines to guide a full review of Section 7, Antimigraine Medicines.

It would seem nobody bothered to take the time to write a good application.