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Price and Affordability of Heart Failure Guideline Directed Medical Therapy in Venezuela: A Cross Sectional
Karim J Gebran-Chedid1,2,3, Diana De Oliveira-Gomes3,4, Gabriela Lombardo3
1Department of Internal Medicine, New York Medical College/Metropolitan Hospital Center, New York, NY, USA.
Insights
Heart failure medications are unaffordable in Venezuela, requiring over 500 work days for a month's treatment. This highlights global access barriers to guideline-directed medical therapy (GDMT) for heart failure (HF).
Area of Science:
- Cardiology
- Pharmacoeconomics
- Global Health
Background:
- Heart failure (HF) affects over 56 million globally, with higher mortality in low and low-middle-income countries (LIC/LMICs).
- Guideline-directed medical therapy (GDMT) is effective for HF with reduced ejection fraction (HFrEF) but faces limited use in LIC/LMICs due to cost and availability.
- Venezuela's ongoing crisis exacerbates these barriers to essential HF treatments.
Purpose of the Study:
- To assess the price and affordability of guideline-directed medical therapy (GDMT) for heart failure (HF) at optimal dosages in Venezuela.
- To compare medication costs against local wages to determine accessibility for patients.
Main Methods:
- A cross-sectional analysis of HF GDMT medication prices was conducted across 13 major pharmacy networks in Venezuela (Dec 2023 - Jan 2024).
- Medications included ACE inhibitors (ACEi), ARBs, BBs, MRAs, ARNIs, and SGLT2i.
- Affordability was calculated using the WHO/HAI methodology, comparing median monthly costs at optimal dosages to the lowest-paid government worker's (LPGW) daily wages and other worker salaries.
Main Results:
- The most expensive regimen was ARNI-based GDMT ($393.81/month), followed by ARB-based ($100.88/month) and ACEi-based ($82.23/month).
- LPGW and retirees would need 506 to 2421 work days to afford one month of optimal HF GDMT.
- All analyzed HF GDMT regimens were deemed unaffordable in Venezuela based on WHO/HAI methodology.
Conclusions:
- All guideline-directed medical therapy (GDMT) regimens for heart failure (HF) are unaffordable in Venezuela.
- Similar affordability challenges in other LIC/LMICs necessitate global advocacy and policy changes.
- Addressing financial barriers is crucial for equitable access to guideline-based HF care worldwide.
Background:
Heart failure (HF) impacts over 56 million people worldwide, with significantly higher mortality rates in low and low-middle-income countries (LIC/LMICs). Despite the effectiveness of guideline-directed medical therapy (GDMT) for HF with reduced ejection fraction (HFrEF), its use remains limited in LIC/LMICs due to limited availability and affordability. These barriers are particularly pressing in Venezuela's context, as the country faces an ongoing crisis.
Objective:
Describe price and affordability of HF Guideline Directed Medical Therapy at optimal dosages in Venezuela.
Methods:
We conducted a cross-sectional analysis from December 2023 to January 2024, surveying prices of HF GDMT medications across 13 major pharmacy networks in Venezuela. Medications analyzed included ACE inhibitors (ACEi), angiotensin receptor blockers (ARB), beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), angiotensin receptor-neprilysin inhibitors (ARNI), and sodium-glucose co-transporter 2 inhibitors (SGLT2i). Affordability was defined and calculated using the World Health Organization/Health Action International (WHO/HAI) methodology, comparing the median costs of one month of HF GDMT at optimal dosages to the lowest-paid government worker's (LPGW) daily wages. Other comparisons of price affordability were made against the mean daily salary of managers, professional and non-professional workers in the country.
Results:
The most expensive medication regime for HF in Venezuela was ARNI-based GDMT with a median monthly cost of 393.81USD, followed by ARB-based GDMT and ACEi-based GDMT costing $100.88USD and $82.23USD respectively. meaning LPGW and elderly receiving retirement stipends would need between 506 to 2421 paid work days to cover one month of treatment at optimal dosages.
Conclusion:
Based on the WHO/HAI methodology all HF GDMT regimens were deemed unaffordable in Venezuela. Similar affordability challenges exist in other LIC/LMICs countries highlighting the need for global advocacy and policy action to address financial barriers to access guideline-based heart failure care.
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