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Availability and affordability of cardiovascular disease medicines and their effect on use in high-income, middle-income, and low-income countries: an analysis of the PURE study data

Summary Background WHO has targeted that medicines to prevent recurrent cardiovascular disease be available in 80% of communities and used by 50% of eligible individuals by 2025. We have previously reported that use of these medicines is very low, but now aim to assess how such low use relates to th... Full description

Journal Title: The Lancet (British edition) 2016, Vol.387 (10013), p.61-69
Main Author: Khatib, Rasha, PhD
Other Authors: McKee, Martin, Prof , Shannon, Harry, Prof , Chow, Clara, PhD , Rangarajan, Sumathy, MSc , Teo, Koon, Prof , Wei, Li, Prof , Mony, Prem, MD , Mohan, Viswanathan, MD , Gupta, Rajeev, PhD , Kumar, Rajesh, MD , Vijayakumar, Krishnapillai, Prof , Lear, Scott A, Prof , Diaz, Rafael, MD , Avezum, Alvaro, PhD , Lopez-Jaramillo, Patricio, Prof , Lanas, Fernando, MD , Yusoff, Khalid, Prof , Ismail, Noorhassim, MD , Kazmi, Khawar, MBBS , Rahman, Omar, Prof , Rosengren, Annika, Prof , Monsef, Nahed, MD , Kelishadi, Roya, Prof , Kruger, Annamarie, Prof , Puoane, Thandi, Prof , Szuba, Andrzej, Prof , Chifamba, Jephat, PhD , Temizhan, Ahmet, MD , Dagenais, Gilles, Prof , Gafni, Amiram, Prof , Yusuf, Salim, Prof
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: England: Elsevier Ltd
ID: ISSN: 0140-6736
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title: Availability and affordability of cardiovascular disease medicines and their effect on use in high-income, middle-income, and low-income countries: an analysis of the PURE study data
format: Article
creator:
  • Khatib, Rasha, PhD
  • McKee, Martin, Prof
  • Shannon, Harry, Prof
  • Chow, Clara, PhD
  • Rangarajan, Sumathy, MSc
  • Teo, Koon, Prof
  • Wei, Li, Prof
  • Mony, Prem, MD
  • Mohan, Viswanathan, MD
  • Gupta, Rajeev, PhD
  • Kumar, Rajesh, MD
  • Vijayakumar, Krishnapillai, Prof
  • Lear, Scott A, Prof
  • Diaz, Rafael, MD
  • Avezum, Alvaro, PhD
  • Lopez-Jaramillo, Patricio, Prof
  • Lanas, Fernando, MD
  • Yusoff, Khalid, Prof
  • Ismail, Noorhassim, MD
  • Kazmi, Khawar, MBBS
  • Rahman, Omar, Prof
  • Rosengren, Annika, Prof
  • Monsef, Nahed, MD
  • Kelishadi, Roya, Prof
  • Kruger, Annamarie, Prof
  • Puoane, Thandi, Prof
  • Szuba, Andrzej, Prof
  • Chifamba, Jephat, PhD
  • Temizhan, Ahmet, MD
  • Dagenais, Gilles, Prof
  • Gafni, Amiram, Prof
  • Yusuf, Salim, Prof
subjects:
  • Abridged Index Medicus
  • Adrenergic beta-Antagonists - economics
  • Adrenergic beta-Antagonists - supply & distribution
  • Adrenergic beta-Antagonists - therapeutic use
  • Analysis
  • Angiotensin-Converting Enzyme Inhibitors - economics
  • Angiotensin-Converting Enzyme Inhibitors - supply & distribution
  • Angiotensin-Converting Enzyme Inhibitors - therapeutic use
  • Argentina
  • Aspirin - economics
  • Aspirin - supply & distribution
  • Aspirin - therapeutic use
  • Bangladesh
  • Brazil
  • Canada
  • Cardiovascular Agents - economics
  • Cardiovascular Agents - supply & distribution
  • Cardiovascular Agents - therapeutic use
  • Cardiovascular disease
  • Cardiovascular diseases
  • Cardiovascular Diseases - drug therapy
  • Chile
  • China
  • Clinical Medicine
  • Colombia
  • Costs
  • Developed Countries
  • Developing Countries
  • Disease prevention
  • Drug Costs
  • Drugs
  • Family Characteristics
  • Health care access
  • Health risk assessment
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors - economics
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors - supply & distribution
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
  • Income
  • India
  • Internal Medicine
  • Iran
  • Klinisk medicin
  • Malaysia
  • Pakistan
  • Pharmacies
  • Platelet Aggregation Inhibitors - economics
  • Platelet Aggregation Inhibitors - supply & distribution
  • Platelet Aggregation Inhibitors - therapeutic use
  • Poland
  • Prevention
  • Preventive medicine
  • Rural Population
  • Secondary Prevention
  • South Africa
  • Sweden
  • Turkey
  • United Arab Emirates
  • Urban Population
  • Usage
  • Zimbabwe
ispartof: The Lancet (British edition), 2016, Vol.387 (10013), p.61-69
description: Summary Background WHO has targeted that medicines to prevent recurrent cardiovascular disease be available in 80% of communities and used by 50% of eligible individuals by 2025. We have previously reported that use of these medicines is very low, but now aim to assess how such low use relates to their lack of availability or poor affordability. Methods We analysed information about availability and costs of cardiovascular disease medicines (aspirin, β blockers, angiotensin-converting enzyme inhibitors, and statins) in pharmacies gathered from 596 communities in 18 countries participating in the Prospective Urban Rural Epidemiology (PURE) study. Medicines were considered available if present at the pharmacy when surveyed, and affordable if their combined cost was less than 20% of household capacity-to-pay. We compared results from high-income, upper middle-income, lower middle-income, and low-income countries. Data from India were presented separately given its large, generic pharmaceutical industry. Findings Communities were recruited between Jan 1, 2003, and Dec 31, 2013. All four cardiovascular disease medicines were available in 61 (95%) of 64 urban and 27 (90%) of 30 rural communities in high-income countries, 53 (80%) of 66 urban and 43 (73%) of 59 rural communities in upper middle-income countries, 69 (62%) of 111 urban and 42 (37%) of 114 rural communities in lower middle-income countries, eight (25%) of 32 urban and one (3%) of 30 rural communities in low-income countries (excluding India), and 34 (89%) of 38 urban and 42 (81%) of 52 rural communities in India. The four cardiovascular disease medicines were potentially unaffordable for 0·14% of households in high-income countries (14 of 9934 households), 25% of upper middle-income countries (6299 of 24 776), 33% of lower middle-income countries (13 253 of 40 023), 60% of low-income countries (excluding India; 1976 of 3312), and 59% households in India (9939 of 16 874). In low-income and middle-income countries, patients with previous cardiovascular disease were less likely to use all four medicines if fewer than four were available (odds ratio [OR] 0·16, 95% CI 0·04–0·57). In communities in which all four medicines were available, patients were less likely to use medicines if the household potentially could not afford them (0·16, 0·04–0·55). Interpretation Secondary prevention medicines are unavailable and unaffordable for a large proportion of communities and households in upper middle-income, lo
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
  • 1474-547X
url: Link


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titleAvailability and affordability of cardiovascular disease medicines and their effect on use in high-income, middle-income, and low-income countries: an analysis of the PURE study data
sourceAlma/SFX Local Collection
creatorKhatib, Rasha, PhD ; McKee, Martin, Prof ; Shannon, Harry, Prof ; Chow, Clara, PhD ; Rangarajan, Sumathy, MSc ; Teo, Koon, Prof ; Wei, Li, Prof ; Mony, Prem, MD ; Mohan, Viswanathan, MD ; Gupta, Rajeev, PhD ; Kumar, Rajesh, MD ; Vijayakumar, Krishnapillai, Prof ; Lear, Scott A, Prof ; Diaz, Rafael, MD ; Avezum, Alvaro, PhD ; Lopez-Jaramillo, Patricio, Prof ; Lanas, Fernando, MD ; Yusoff, Khalid, Prof ; Ismail, Noorhassim, MD ; Kazmi, Khawar, MBBS ; Rahman, Omar, Prof ; Rosengren, Annika, Prof ; Monsef, Nahed, MD ; Kelishadi, Roya, Prof ; Kruger, Annamarie, Prof ; Puoane, Thandi, Prof ; Szuba, Andrzej, Prof ; Chifamba, Jephat, PhD ; Temizhan, Ahmet, MD ; Dagenais, Gilles, Prof ; Gafni, Amiram, Prof ; Yusuf, Salim, Prof
creatorcontribKhatib, Rasha, PhD ; McKee, Martin, Prof ; Shannon, Harry, Prof ; Chow, Clara, PhD ; Rangarajan, Sumathy, MSc ; Teo, Koon, Prof ; Wei, Li, Prof ; Mony, Prem, MD ; Mohan, Viswanathan, MD ; Gupta, Rajeev, PhD ; Kumar, Rajesh, MD ; Vijayakumar, Krishnapillai, Prof ; Lear, Scott A, Prof ; Diaz, Rafael, MD ; Avezum, Alvaro, PhD ; Lopez-Jaramillo, Patricio, Prof ; Lanas, Fernando, MD ; Yusoff, Khalid, Prof ; Ismail, Noorhassim, MD ; Kazmi, Khawar, MBBS ; Rahman, Omar, Prof ; Rosengren, Annika, Prof ; Monsef, Nahed, MD ; Kelishadi, Roya, Prof ; Kruger, Annamarie, Prof ; Puoane, Thandi, Prof ; Szuba, Andrzej, Prof ; Chifamba, Jephat, PhD ; Temizhan, Ahmet, MD ; Dagenais, Gilles, Prof ; Gafni, Amiram, Prof ; Yusuf, Salim, Prof ; PURE study investigators ; Sahlgrenska akademin ; Institute of Medicine, Department of Molecular and Clinical Medicine ; Institutionen för medicin, avdelningen för molekylär och klinisk medicin ; Göteborgs universitet ; Gothenburg University ; Sahlgrenska Academy
descriptionSummary Background WHO has targeted that medicines to prevent recurrent cardiovascular disease be available in 80% of communities and used by 50% of eligible individuals by 2025. We have previously reported that use of these medicines is very low, but now aim to assess how such low use relates to their lack of availability or poor affordability. Methods We analysed information about availability and costs of cardiovascular disease medicines (aspirin, β blockers, angiotensin-converting enzyme inhibitors, and statins) in pharmacies gathered from 596 communities in 18 countries participating in the Prospective Urban Rural Epidemiology (PURE) study. Medicines were considered available if present at the pharmacy when surveyed, and affordable if their combined cost was less than 20% of household capacity-to-pay. We compared results from high-income, upper middle-income, lower middle-income, and low-income countries. Data from India were presented separately given its large, generic pharmaceutical industry. Findings Communities were recruited between Jan 1, 2003, and Dec 31, 2013. All four cardiovascular disease medicines were available in 61 (95%) of 64 urban and 27 (90%) of 30 rural communities in high-income countries, 53 (80%) of 66 urban and 43 (73%) of 59 rural communities in upper middle-income countries, 69 (62%) of 111 urban and 42 (37%) of 114 rural communities in lower middle-income countries, eight (25%) of 32 urban and one (3%) of 30 rural communities in low-income countries (excluding India), and 34 (89%) of 38 urban and 42 (81%) of 52 rural communities in India. The four cardiovascular disease medicines were potentially unaffordable for 0·14% of households in high-income countries (14 of 9934 households), 25% of upper middle-income countries (6299 of 24 776), 33% of lower middle-income countries (13 253 of 40 023), 60% of low-income countries (excluding India; 1976 of 3312), and 59% households in India (9939 of 16 874). In low-income and middle-income countries, patients with previous cardiovascular disease were less likely to use all four medicines if fewer than four were available (odds ratio [OR] 0·16, 95% CI 0·04–0·57). In communities in which all four medicines were available, patients were less likely to use medicines if the household potentially could not afford them (0·16, 0·04–0·55). Interpretation Secondary prevention medicines are unavailable and unaffordable for a large proportion of communities and households in upper middle-income, lower middle-income, and low-income countries, which have very low use of these medicines. Improvements to the availability and affordability of key medicines is likely to enhance their use and help towards achieving WHO's targets of 50% use of key medicines by 2025. Funding Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, GlaxoSmithKline, Novartis, King Pharma, and national or local organisations in participating countries.
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languageeng
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0Khatib, Rasha, PhD
1McKee, Martin, Prof
2Shannon, Harry, Prof
3Chow, Clara, PhD
4Rangarajan, Sumathy, MSc
5Teo, Koon, Prof
6Wei, Li, Prof
7Mony, Prem, MD
8Mohan, Viswanathan, MD
9Gupta, Rajeev, PhD
10Kumar, Rajesh, MD
11Vijayakumar, Krishnapillai, Prof
12Lear, Scott A, Prof
13Diaz, Rafael, MD
14Avezum, Alvaro, PhD
15Lopez-Jaramillo, Patricio, Prof
16Lanas, Fernando, MD
17Yusoff, Khalid, Prof
18Ismail, Noorhassim, MD
19Kazmi, Khawar, MBBS
20Rahman, Omar, Prof
21Rosengren, Annika, Prof
22Monsef, Nahed, MD
23Kelishadi, Roya, Prof
24Kruger, Annamarie, Prof
25Puoane, Thandi, Prof
26Szuba, Andrzej, Prof
27Chifamba, Jephat, PhD
28Temizhan, Ahmet, MD
29Dagenais, Gilles, Prof
30Gafni, Amiram, Prof
31Yusuf, Salim, Prof
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33Sahlgrenska akademin
34Institute of Medicine, Department of Molecular and Clinical Medicine
35Institutionen för medicin, avdelningen för molekylär och klinisk medicin
36Göteborgs universitet
37Gothenburg University
38Sahlgrenska Academy
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0Availability and affordability of cardiovascular disease medicines and their effect on use in high-income, middle-income, and low-income countries: an analysis of the PURE study data
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descriptionSummary Background WHO has targeted that medicines to prevent recurrent cardiovascular disease be available in 80% of communities and used by 50% of eligible individuals by 2025. We have previously reported that use of these medicines is very low, but now aim to assess how such low use relates to their lack of availability or poor affordability. Methods We analysed information about availability and costs of cardiovascular disease medicines (aspirin, β blockers, angiotensin-converting enzyme inhibitors, and statins) in pharmacies gathered from 596 communities in 18 countries participating in the Prospective Urban Rural Epidemiology (PURE) study. Medicines were considered available if present at the pharmacy when surveyed, and affordable if their combined cost was less than 20% of household capacity-to-pay. We compared results from high-income, upper middle-income, lower middle-income, and low-income countries. Data from India were presented separately given its large, generic pharmaceutical industry. Findings Communities were recruited between Jan 1, 2003, and Dec 31, 2013. All four cardiovascular disease medicines were available in 61 (95%) of 64 urban and 27 (90%) of 30 rural communities in high-income countries, 53 (80%) of 66 urban and 43 (73%) of 59 rural communities in upper middle-income countries, 69 (62%) of 111 urban and 42 (37%) of 114 rural communities in lower middle-income countries, eight (25%) of 32 urban and one (3%) of 30 rural communities in low-income countries (excluding India), and 34 (89%) of 38 urban and 42 (81%) of 52 rural communities in India. The four cardiovascular disease medicines were potentially unaffordable for 0·14% of households in high-income countries (14 of 9934 households), 25% of upper middle-income countries (6299 of 24 776), 33% of lower middle-income countries (13 253 of 40 023), 60% of low-income countries (excluding India; 1976 of 3312), and 59% households in India (9939 of 16 874). In low-income and middle-income countries, patients with previous cardiovascular disease were less likely to use all four medicines if fewer than four were available (odds ratio [OR] 0·16, 95% CI 0·04–0·57). In communities in which all four medicines were available, patients were less likely to use medicines if the household potentially could not afford them (0·16, 0·04–0·55). Interpretation Secondary prevention medicines are unavailable and unaffordable for a large proportion of communities and households in upper middle-income, lower middle-income, and low-income countries, which have very low use of these medicines. Improvements to the availability and affordability of key medicines is likely to enhance their use and help towards achieving WHO's targets of 50% use of key medicines by 2025. Funding Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, GlaxoSmithKline, Novartis, King Pharma, and national or local organisations in participating countries.
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0Abridged Index Medicus
1Adrenergic beta-Antagonists - economics
2Adrenergic beta-Antagonists - supply & distribution
3Adrenergic beta-Antagonists - therapeutic use
4Analysis
5Angiotensin-Converting Enzyme Inhibitors - economics
6Angiotensin-Converting Enzyme Inhibitors - supply & distribution
7Angiotensin-Converting Enzyme Inhibitors - therapeutic use
8Argentina
9Aspirin - economics
10Aspirin - supply & distribution
11Aspirin - therapeutic use
12Bangladesh
13Brazil
14Canada
15Cardiovascular Agents - economics
16Cardiovascular Agents - supply & distribution
17Cardiovascular Agents - therapeutic use
18Cardiovascular disease
19Cardiovascular diseases
20Cardiovascular Diseases - drug therapy
21Chile
22China
23Clinical Medicine
24Colombia
25Costs
26Developed Countries
27Developing Countries
28Disease prevention
29Drug Costs
30Drugs
31Family Characteristics
32Health care access
33Health risk assessment
34Humans
35Hydroxymethylglutaryl-CoA Reductase Inhibitors - economics
36Hydroxymethylglutaryl-CoA Reductase Inhibitors - supply & distribution
37Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
38Income
39India
40Internal Medicine
41Iran
42Klinisk medicin
43Malaysia
44Pakistan
45Pharmacies
46Platelet Aggregation Inhibitors - economics
47Platelet Aggregation Inhibitors - supply & distribution
48Platelet Aggregation Inhibitors - therapeutic use
49Poland
50Prevention
51Preventive medicine
52Rural Population
53Secondary Prevention
54South Africa
55Sweden
56Turkey
57United Arab Emirates
58Urban Population
59Usage
60Zimbabwe
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8Mohan, Viswanathan, MD
9Gupta, Rajeev, PhD
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13Diaz, Rafael, MD
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23Kelishadi, Roya, Prof
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25Puoane, Thandi, Prof
26Szuba, Andrzej, Prof
27Chifamba, Jephat, PhD
28Temizhan, Ahmet, MD
29Dagenais, Gilles, Prof
30Gafni, Amiram, Prof
31Yusuf, Salim, Prof
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titleAvailability and affordability of cardiovascular disease medicines and their effect on use in high-income, middle-income, and low-income countries: an analysis of the PURE study data
authorKhatib, Rasha, PhD ; McKee, Martin, Prof ; Shannon, Harry, Prof ; Chow, Clara, PhD ; Rangarajan, Sumathy, MSc ; Teo, Koon, Prof ; Wei, Li, Prof ; Mony, Prem, MD ; Mohan, Viswanathan, MD ; Gupta, Rajeev, PhD ; Kumar, Rajesh, MD ; Vijayakumar, Krishnapillai, Prof ; Lear, Scott A, Prof ; Diaz, Rafael, MD ; Avezum, Alvaro, PhD ; Lopez-Jaramillo, Patricio, Prof ; Lanas, Fernando, MD ; Yusoff, Khalid, Prof ; Ismail, Noorhassim, MD ; Kazmi, Khawar, MBBS ; Rahman, Omar, Prof ; Rosengren, Annika, Prof ; Monsef, Nahed, MD ; Kelishadi, Roya, Prof ; Kruger, Annamarie, Prof ; Puoane, Thandi, Prof ; Szuba, Andrzej, Prof ; Chifamba, Jephat, PhD ; Temizhan, Ahmet, MD ; Dagenais, Gilles, Prof ; Gafni, Amiram, Prof ; Yusuf, Salim, Prof
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0Abridged Index Medicus
1Adrenergic beta-Antagonists - economics
2Adrenergic beta-Antagonists - supply & distribution
3Adrenergic beta-Antagonists - therapeutic use
4Analysis
5Angiotensin-Converting Enzyme Inhibitors - economics
6Angiotensin-Converting Enzyme Inhibitors - supply & distribution
7Angiotensin-Converting Enzyme Inhibitors - therapeutic use
8Argentina
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creatorcontrib
0Khatib, Rasha, PhD
1McKee, Martin, Prof
2Shannon, Harry, Prof
3Chow, Clara, PhD
4Rangarajan, Sumathy, MSc
5Teo, Koon, Prof
6Wei, Li, Prof
7Mony, Prem, MD
8Mohan, Viswanathan, MD
9Gupta, Rajeev, PhD
10Kumar, Rajesh, MD
11Vijayakumar, Krishnapillai, Prof
12Lear, Scott A, Prof
13Diaz, Rafael, MD
14Avezum, Alvaro, PhD
15Lopez-Jaramillo, Patricio, Prof
16Lanas, Fernando, MD
17Yusoff, Khalid, Prof
18Ismail, Noorhassim, MD
19Kazmi, Khawar, MBBS
20Rahman, Omar, Prof
21Rosengren, Annika, Prof
22Monsef, Nahed, MD
23Kelishadi, Roya, Prof
24Kruger, Annamarie, Prof
25Puoane, Thandi, Prof
26Szuba, Andrzej, Prof
27Chifamba, Jephat, PhD
28Temizhan, Ahmet, MD
29Dagenais, Gilles, Prof
30Gafni, Amiram, Prof
31Yusuf, Salim, Prof
32PURE study investigators
33Sahlgrenska akademin
34Institute of Medicine, Department of Molecular and Clinical Medicine
35Institutionen för medicin, avdelningen för molekylär och klinisk medicin
36Göteborgs universitet
37Gothenburg University
38Sahlgrenska Academy
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jtitleThe Lancet (British edition)
delivery
delcategoryRemote Search Resource
fulltextfulltext
addata
au
0Khatib, Rasha, PhD
1McKee, Martin, Prof
2Shannon, Harry, Prof
3Chow, Clara, PhD
4Rangarajan, Sumathy, MSc
5Teo, Koon, Prof
6Wei, Li, Prof
7Mony, Prem, MD
8Mohan, Viswanathan, MD
9Gupta, Rajeev, PhD
10Kumar, Rajesh, MD
11Vijayakumar, Krishnapillai, Prof
12Lear, Scott A, Prof
13Diaz, Rafael, MD
14Avezum, Alvaro, PhD
15Lopez-Jaramillo, Patricio, Prof
16Lanas, Fernando, MD
17Yusoff, Khalid, Prof
18Ismail, Noorhassim, MD
19Kazmi, Khawar, MBBS
20Rahman, Omar, Prof
21Rosengren, Annika, Prof
22Monsef, Nahed, MD
23Kelishadi, Roya, Prof
24Kruger, Annamarie, Prof
25Puoane, Thandi, Prof
26Szuba, Andrzej, Prof
27Chifamba, Jephat, PhD
28Temizhan, Ahmet, MD
29Dagenais, Gilles, Prof
30Gafni, Amiram, Prof
31Yusuf, Salim, Prof
aucorp
0PURE study investigators
1Sahlgrenska akademin
2Institute of Medicine, Department of Molecular and Clinical Medicine
3Institutionen för medicin, avdelningen för molekylär och klinisk medicin
4Göteborgs universitet
5Gothenburg University
6Sahlgrenska Academy
formatjournal
genrearticle
ristypeJOUR
atitleAvailability and affordability of cardiovascular disease medicines and their effect on use in high-income, middle-income, and low-income countries: an analysis of the PURE study data
jtitleThe Lancet (British edition)
addtitleLancet
date2016
risdate2016
volume387
issue10013
spage61
epage69
pages61-69
issn
00140-6736
11474-547X
eissn1474-547X
codenLANCAO
abstractSummary Background WHO has targeted that medicines to prevent recurrent cardiovascular disease be available in 80% of communities and used by 50% of eligible individuals by 2025. We have previously reported that use of these medicines is very low, but now aim to assess how such low use relates to their lack of availability or poor affordability. Methods We analysed information about availability and costs of cardiovascular disease medicines (aspirin, β blockers, angiotensin-converting enzyme inhibitors, and statins) in pharmacies gathered from 596 communities in 18 countries participating in the Prospective Urban Rural Epidemiology (PURE) study. Medicines were considered available if present at the pharmacy when surveyed, and affordable if their combined cost was less than 20% of household capacity-to-pay. We compared results from high-income, upper middle-income, lower middle-income, and low-income countries. Data from India were presented separately given its large, generic pharmaceutical industry. Findings Communities were recruited between Jan 1, 2003, and Dec 31, 2013. All four cardiovascular disease medicines were available in 61 (95%) of 64 urban and 27 (90%) of 30 rural communities in high-income countries, 53 (80%) of 66 urban and 43 (73%) of 59 rural communities in upper middle-income countries, 69 (62%) of 111 urban and 42 (37%) of 114 rural communities in lower middle-income countries, eight (25%) of 32 urban and one (3%) of 30 rural communities in low-income countries (excluding India), and 34 (89%) of 38 urban and 42 (81%) of 52 rural communities in India. The four cardiovascular disease medicines were potentially unaffordable for 0·14% of households in high-income countries (14 of 9934 households), 25% of upper middle-income countries (6299 of 24 776), 33% of lower middle-income countries (13 253 of 40 023), 60% of low-income countries (excluding India; 1976 of 3312), and 59% households in India (9939 of 16 874). In low-income and middle-income countries, patients with previous cardiovascular disease were less likely to use all four medicines if fewer than four were available (odds ratio [OR] 0·16, 95% CI 0·04–0·57). In communities in which all four medicines were available, patients were less likely to use medicines if the household potentially could not afford them (0·16, 0·04–0·55). Interpretation Secondary prevention medicines are unavailable and unaffordable for a large proportion of communities and households in upper middle-income, lower middle-income, and low-income countries, which have very low use of these medicines. Improvements to the availability and affordability of key medicines is likely to enhance their use and help towards achieving WHO's targets of 50% use of key medicines by 2025. Funding Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, GlaxoSmithKline, Novartis, King Pharma, and national or local organisations in participating countries.
copEngland
pubElsevier Ltd
pmid26498706
doi10.1016/S0140-6736(15)00469-9