Availability, price and affordability of cardiovascular medicines: A comparison across 36 countries using WHO/HAI data

Abstract

BackgroundThe 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.MethodsThe 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.ResultsFor 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.ConclusionsThe 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.

Differences in the availability of medicines for chronic and acute conditions in the public and private sectors of developing countries

“…1). However, as previously reported, 19 in some therapeutic classes (e.g. antidiabetics and antihypertensives) substantial variation was observed in the availability of individual medicines.…”

“…Further, in the private sector, medicines for chronic conditions usually cost substantially more than in the public sector and are often unaffordable. 11,[19][20][21][22][23][24][25]34 Chronic disease patients, who need lifelong treatment, may find these medicines even less affordable than other patients. In developing countries, catastrophic health spending (e.g.…”

“…11 Studies focused on medicines used to treat chronic conditions have shown similar results. [19][20][21][22][23][24][25] However, no studies to date have investigated whether medicines for chronic conditions are less available than medicines in other therapeutic categories. We hypothesized that in countries with weak health systems that have historically focused on infectious diseases, medicines for chronic conditions requiring ongoing management are less available than Abstracts in ‫,عريب‬ 中文, Français, Pусский and Español at the end of each article.…”

Understanding and Advancing the Health of Older Populations in sub-Saharan Africa: Policy Perspectives and Evidence Needs

“…Indications of some of these factors are provided by a number of small scale, qualitative studies on care seeking among older people or diabetes sufferers, 46,76,77 analyses of the availability and cost of essential CNCD drugs, 78,79 and general examinations of impacts of user fee or quality changes on health service utilization in SSA countries. 64,[80][81][82][83] The findings point to negative impacts of physical and logistical access difficulties, financial barriers related to service fees and/or transport costs and a perceived lack of quality (or unavailability altogether) of requisite services in the public sector.…”

A comparative evaluation of the quality of ten generic telmisartan tablets with the brand

“…As a strategy to reduce the costs and the amount of money used to buy pharmaceuticals, many countries promote the use of generic drugs (King and Kanavos, 2002). This strategy to contain drug expenditure seem to work best for those patients suffering from chronic diseases like hypertension as there is a possibility for the patients to remain under medication for the rest of their life Van Mourik et al, 2010). This effort to reduce drug expenditure is undermined by the belief that generic drugs are inferior in quality and safety to their brand name drugs (Berg et al, 2008;; some people even doubting if the process used to approve generic medicines can guarantee the efficacy and safeness of generic drugs (Blier, 2007).…”