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Availability, price and affordability of cardiovascular medicines: a comparison across 36 countries using WHO/HAI
Maaike S M van Mourik1, Alexandra Cameron, Marg Ewen
1Faculty of Medicine, University Medical Centre, Utrecht, The Netherlands. vanmourikmaaike@hotmail.com
Insights
Cardiovascular medicines are often unavailable and unaffordable in developing nations, particularly in the public sector. Improving access to essential cardiovascular drugs is crucial for managing the rising global burden of cardiovascular disease.
Area of Science:
- Pharmacoeconomics
- Global Health
- Cardiovascular Medicine
Background:
- Cardiovascular disease (CVD) presents a growing global health challenge.
- Effective pharmaceutical management is vital for successful CVD treatment.
- This study assesses the availability, pricing, and affordability of CVD medicines in developing countries.
Purpose of the Study:
- To evaluate the availability and cost of essential cardiovascular drugs in developing countries.
- To compare patient and procurement prices against international benchmarks.
- To determine the affordability of chronic cardiovascular medication for low-income populations.
Main Methods:
- Utilized standardized World Health Organization/Health Action International methodology.
- Analyzed data from 36 countries on 5 key cardiovascular medicines (atenolol, captopril, hydrochlorothiazide, losartan, nifedipine).
- Assessed availability, price ratios, and affordability based on a lowest-paid unskilled government worker's wages.
Main Results:
- Significant variability observed in medicine availability and pricing across countries.
- Overall availability of cardiovascular medicines was poor, especially in the public sector (26.3% vs. 57.3% in private).
- Patient prices frequently exceeded international reference prices, and chronic treatment was often unaffordable, particularly for combination therapies.
Conclusions:
- Urgent attention and funding are needed to improve access to chronic disease medicines, particularly in public healthcare systems.
- Policy interventions are necessary to enhance the accessibility and affordability of essential cardiovascular drugs.
- Addressing medication accessibility is critical for managing the global burden of cardiovascular disease.
Background:
The global burden of cardiovascular disease (CVD) continues to rise. Successful treatment of CVD requires adequate pharmaceutical management. The aim was to examine the availability, pricing and affordability of cardiovascular medicines in developing countries using the standardized data collected according to the World Health Organization/Health Action International methodology.
Methods:
The following medicines were included: atenolol, captopril, hydrochlorothiazide, losartan and nifedipine. Data from 36 countries were analyzed. Outcome measures were percentage availability, price ratios to international reference prices and number of day's wages needed by the lowest-paid unskilled government worker to purchase one month of chronic treatment. Patient prices were adjusted for inflation and purchasing power, procurement prices only for inflation. Data were analyzed for both generic and originator brand products and the public and private sector and summarized by World Bank Income Groups.
Results:
For all measures, there was great variability across surveys. The overall availability of cardiovascular medicines was poor (mean 26.3% in public sector, 57.3% private sector). Procurement prices were very competitive in some countries, whereas others consistently paid high prices. Patient prices were generally substantially higher than international references prices; some countries, however, performed well. Chronic treatment with anti-hypertensive medication cost more than one day's wages in many cases. In particular when monotherapy is insufficient, treatment became unaffordable.
Conclusions:
The results of this study emphasize the need of focusing attention and financing on making chronic disease medicines accessible, in particular in the public sector. Several policy options are suggested to reach this goal.
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