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Secondary CVD medicines often unavailable, unaffordable in low-, middle-income countries
Medications recommended for secondary prevention of CVD are frequently unavailable or unaffordable in communities within low- to middle-income countries, according to findings from the PURE study published in The Lancet.
In an observational analysis conducted from 2003 to 2013, Rasha Khatib, PhD, of the Institute of Public Health, Birzeit University, Birzeit, occupied Palestinian territory, evaluated the costs and availability of four medications: aspirin, beta-blockers, ACE inhibitors and statins.
They analyzed cross-sectional data of patients with CVD aged 35 to 70 years from 596 communities in 18 countries participating in the PURE study (n = 7,013), and categorized availability according to presence in surveyed pharmacies and affordability according to whether the combined cost of the medications was less than 20% of a household’s capacity-to-pay, or the amount of income remaining after meeting basic subsistence needs.
All four assessed medications were available in 95% of urban and 90% of rural communities in high-income countries; 80% of urban and 73% of rural communities in upper middle-income countries; 62% of urban and 37% of rural communities in lower middle-income countries; and 25% of urban and 3% of rural communities in low-income countries. Due to its large generic pharmaceutical industry, India was analyzed separately showing availability at 89% of urban and 81% of rural communities.
Medications were considered unaffordable for 0.14% of households in high-income countries; 25% of households in upper-middle income countries; 33% of households in lower-middle income countries; 60% of households in low-income countries, and 59% of households in India. Use of all four medicines was less common among patients with prior CVD in low- and middle-income countries where fewer than four of the medicines were available (OR = 0.16; 95% CI, 0.04-0.57). In countries where all four medicines were available, the likelihood of use was lower in households that could not afford them (OR = 0.16; 95% CI, 0.04-0.55).
“The medicines assessed in this paper have been shown to prevent recurrent CVD events and reduce mortality rates, and are recommended for use in most clinical guidelines,” the researchers wrote. “However, these medicines are not available in a large proportion of communities in low-income and middle-income countries and if available they are not always affordable … Unless both availability and affordability of these medicines are improved, their use is likely to remain low in most of the world.”
In a related editorial published in The Lancet, Louis W. Niessen, MD, and Jahangir A. M. Khan, PhD, both health economists from the Centre for Applied Health Research and Delivery, Liverpool School of Tropical Medicine, noted that the findings may have widespread implications beyond CVD and “are important in the formulation of policies for universal health coverage and the mobilization of health care resources … Universal access to medicines will be accelerated through increased health financing and greater availability of low-cost medicines targeting major diseases among people with low incomes.” – by Trish Shea, MA
Disclosure: Khatib reports receiving support from the International Development Centre and the Population Health Research Institute. Another researcher reports receiving support from the Heart Foundation and the Australian National Health and Medical Research Council, AstraZeneca and Sanofi. Niessen and Khan report no relevant financial disclosures.