Access to Essential Cardiovascular Medicines in Pakistan: A National Survey on the Availability, Price, and Affordability, Using WHO/HAI Methodology

Abstract

Objective: This national survey was aimed at measuring the access to cardiovascular disease (CVD) medicines in terms of their availability, price, and affordability in Pakistan. This was done by using the standard WHO/Health Action International (HAI) methodology.Methods: The price and availability data for 18 CVD medicines were collected from public sector hospitals (n = 40) and private sector retail pharmacies (n = 40) in eight cities of Pakistan. The outcome measures were availability (calculated as percentage of health facilities stocked with listed medicines), medicine price to the international reference price ratio (i.e., median price ratio (MPR)), and affordability (calculated as number of days’ wages (NDWs) of the lowest paid unskilled government worker required to afford one-month treatment of a chronic disease). The affordability of standard treatment in Pakistan with four CVD drugs was compared with data from six other low and middle income countries (LMICs) using HAI database.Findings: The mean percent availability of CVD medicines was significantly low (p < 0.001) in the public sector as compared to the private sector, that is, 25.5% vs. 54.6% for originator brands (OBs) and 30.4% vs. 34.9% for lowest price generics (LPGs), respectively. For all OBs and LPGs, the inflation-adjusted mean MPR was 2.72 and 1, respectively. CVD medicines were found to be unaffordable with average NDWs of 6.4 and 2.2 for OBs and LPGs, respectively, that is, NDWs of more than 1. In international comparison with countries such as Sudan, Lebanon, Egypt, India, Afghanistan, and China, the affordability of standard treatment with selected CVD medicines (atenolol, amlodipine, captopril, and simvastatin) in Pakistan was found to be low. Overall, all four OBs and three out of four LPGs of selected CVD drugs were found unaffordable in Pakistan.Conclusion: This data indicated that the availability of selected CVD medicines was low in both public and private sector medicine outlets. Both OBs and LPGs were found unaffordable in the private sector, necessitating the redressal of pricing policies, structuring, and their implementation.

Availability of essential medicines in Pakistan—A comprehensive document analysis

“…This is a first study of its kind that analyses the NEML for important requisites regarding availability of medicines using comprehensive document analysis using sources other than NEMLPK. Publications related to availability of EMs in Pakistan are scarce and are limited to market surveys carried out on a few selected EMs mostly including registered medicines [25][26][27][28]. There are some studies based on qualitative data as well [15,29].…”

“…The percentage of countries with non-availability status was somewhat higher than for licensing figures except for fluconazole that was available in 5 countries under special programs [ 30 ]. The recent literature on availability of EMs in Pakistan is still scarce, sporadically covering only a few classes of medicines including cardiovascular [ 27 , 28 ], anti-infectives [ 30 , 31 ] respiratory medicines [ 25 ] along with some reports and studies on generalized group of medicines [ 13 , 14 , 26 ] None of the studies covered the complete range of EMs for the studied category but include only a few selected medicines.…”

“…still scarce, sporadically covering only a few classes of medicines including cardiovascular [27,28], anti-infectives [30,31] respiratory medicines [25] along with some reports and studies on generalized group of medicines [13,14,26] None of the studies covered the complete range of EMs for the studied category but include only a few selected medicines.…”

Factors associated with the availability and affordability of essential cardiovascular disease medicines in low- and middle-income countries: A systematic review

“…Detailed characteristics of included studies and the results of risk of bias assessments are described in Table 2. Seven of the included studies used the WHO Health Action International survey [20,22,23,26,28,30,31,53,56] and six used the Service Availability and Readiness Assessment tool to measure medicine availability [17,18,24,27,29,38,52]. Definitions and quantification approaches used to measure availability and affordability are presented in Tables 3 and 4, respectively.…”

“…Health sector (program) level. Eight studies examined health sector level arrangements [20,26,28,35,42,44,54,56]. Three studies from Brazil, China, and Nigeria all point to an association between facility revenues and medicine availability [26,35,44].…”