Availability, price and affordability of essential medicines for managing cardiovascular diseases and diabetes: a statewide survey in Kerala, India

Abstract

objective Limited access to essential medicines (EMs) for cardiovascular disease (CVD) and diabetes is a major concern in low-and middle-income countries. We aimed to generate data on availability, price and affordability of EMs for CVD and diabetes in India. methods Using WHO/HAI survey methodology, we evaluated availability and prices of 23 EMs in 30 public sector facilities (government hospitals and semi-public/government-subsidised-discountpharmacies (GSDPs)) and 60 private retail pharmacies across six districts in Kerala state, India (November 2018-May 2019). Median Price Ratios (MPRs) were calculated by comparing consumer prices with international reference prices. We also analysed data (collected in July 2020) on six anti-hypertensive fixed-dose-combinations (FDCs) that were designated as 'essential' by the WHO in 2019. results Mean availability of surveyed generic EMs was 45.7% in government hospitals, 64.7% in GSDPs and 72.0% in private retail pharmacies. On average, the most-sold and highest-priced generics, respectively, were 6.6% and 8.9% costlier than the lowest-priced generics (LPG). Median MPR for LPG was 2.71 in private retail and 2.25 in GSDPs. Monthly supply of LPG would cost the lowestpaid worker 1.11 and 0.79 days' wages in private retail and GSDPs, respectively. Mean availability of the surveyed FDCs was poor (private retail: 15-85%; GSDPs: 8.3-66.7%), and the private retail prices of FDCs were comparable to the sum of corresponding constituent monotherapies. conclusion Availability of CVD and diabetes EMs fall short of WHO's 80% target in both sectors. Although availability in the private retail pharmacies was near-optimal, prices appear unaffordable compared to GSDPs. Initiatives such as mandating generic prescribing, adding the WHO-approved FDCs in local EM lists, improving price transparency, and streamlining medicine supply to ensure equitable access to EMs, especially in the public sector, are crucial in tackling Kerala's ever-increasing CVD burden. keywords cardiovascular disease, diabetes, access to medicines, essential medicines, India Sustainable Development Goals (SDGs): SDG 1 (no poverty), SDG 3 (good health and well-being), SDG 10 (reduced inequalities), SDG 16 (peace, justice and strong institutions), SDG 17 (partnerships for the goals) *Equal contribution, joint first authors. † Equal contribution, joint last authors.

Health System Capacity and Access Barriers to Diagnosis and Treatment of CVD and Diabetes in Nepal

“…Several of the surveyed medicines (over 35% in public sector and 50% in private sector) cost more than 1-days wage (Table 1 ). One measure towards reducing cost of medicines would be to update the Nepalese EML and clinical guidelines to adopt BP-lowering FDCs that were recently included in the 2019 WHO EML based on their clinical efficacy and lower costs [ 32 33 ].…”

“…Nepal's 2016 EML has 10 medicines [i.e., oral formulations of disopyramide, fenofibrate, glipizide, nifedipine, prazosin, procainamide and ramipril, and injections of dobutamine, isoprenaline, labetalol and procainamide] that are not listed in either the 2017 or 2019 WHO Global EML. Furthermore, the WHO approved four blood pressure (BP)-lowering fixed-dose combinations (FDCs) for inclusion in the 2019 Global EML, and these FDCs are not listed in the Nepalese 2016 EML [32,33]. See details in Appendix E Table 4.…”

Availability and Affordability of Medicines for Diabetes and Cardiovascular Disease across Countries: Information Learned from the Prospective Urban Rural Epidemiological Study

“…Besides the PURE study, several other studies have also provided evidence on the issue of availability and affordability of essential cardiovascular medicine in low-and middle-income countries [6,[24][25][26][27][28]. A recent state-wide survey in India on the availability, price, and affordability of 23 essential medicines for diabetes and CVD revealed that the availability of these essential medicines failed to reach WHO's 80% target in both the public and private sectors, and, although availability in the private retail pharmacies was near-optimal, medicine prices were unaffordable compared to the public sector [29]. In a study published in 2020 based on data from 84 surveys of 59 countries from the WHO's Health Action International Project to provide a cross-country assessment of availability and affordability of cardiovascular medicine and antihypertensive medicine [8], there was an insufficient availability of cardiovascular and hypertension medicines in low-resource countries with a high prevalence of hypertension.…”

Influence of Logistics Management on Availability and Affordability of Antihypertensive Medicines in Rwanda. Case Study: RMS Ltd and District Hospitals

“…Similary a study conducted in delevolopping country has revelead low availability of antihypertensive medicines at 60% and 58.2% as revelead by the study conducted in the Lusaka distict in Zambia. Another study conducted in india has revealed low availability of NCDs [4]. In Rwanda the study conducted in 2017, has shown low availability of majority of antihypertensive medicines at the rate of 44.4% [5] .…”