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Open Access Highly Accessed Research article

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

Maaike SM van Mourik12*, Alexandra Cameron23, Marg Ewen4 and Richard O Laing2

Author Affiliations

1 Student at the Faculty of Medicine, University Medical Centre, Utrecht, The Netherlands

2 Department of Essential Medicines and Pharmaceutical Policies, World Health Organization, Geneva, Switzerland

3 Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands

4 Health Action International Global, Amsterdam, The Netherlands

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BMC Cardiovascular Disorders 2010, 10:25  doi:10.1186/1471-2261-10-25

Published: 9 June 2010

Abstract

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.