Availability, price and affordability of cardiovascular medicines: a comparison across 36 countries using WHO/HAI data.
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.
Faculty of Medicine, University Medical Centre, Utrecht, The Netherlands. vanmourikmaaike@hotmail.com
Maaike S M
MS
van Mourik
Alexandra
A
Cameron
Marg
M
Ewen
Richard O
RO
Laing
D000959:Antihypertensive Agents / Q000191:economics / Q000600:supply & distribution / Q000627:therapeutic use*; D001262:Atenolol / Q000008:administration & dosage; D002216:Captopril / Q000008:administration & dosage; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D017281:Cost of Illness; D003906:Developing Countries; D006297:Health Services Accessibility; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage; D019808:Losartan / Q000008:administration & dosage; D009543:Nifedipine / Q000008:administration & dosage; D014944:World Health Organization / Q000191:economics
D000959:Antihypertensive Agents; D006852:Hydrochlorothiazide; D001262:Atenolol; D002216:Captopril; D009543:Nifedipine; D019808:Losartan