Access to Medicines for Cardiovascular Disease and Hypertension Control: A Cross-Country Analysis of Prices, Availability, and Affordability

Introduction: Access to medicine is critical for long-term care of cardiovascular diseases (CVDs) and hypertension. In many countries, essential medicines may not be available, accessible, or affordable. This study provides a cross-country assessment of prices, availability and affordability of CVD and hypertension medicines to identify areas for improvement in access to medication treatment.

Methods: We used survey data from the World Health Organization Health Action International database on 58 countries from 2001-2015 to analyze the following indicators: (a) availability, measured as the percentage of healthcare facilities where the medicine is offered; (b) price, expressed as the median price ratio (MPR) to international reference prices, adjusted for inflation and purchasing power; and (c) affordability, measured as the number of day's wages needed to purchase one month of treatment. We aggregated the indicators across lowest-price generic and originator brand medicines and by country income group, distinguishing between low and middle-income countries (LMICs) and high and upper middle-income countries (HUMICs).

Results: The average availability for the select medicines was 54% in LMICs and 60% in HUMICs, and was higher for generic (61%) compared to brand medicines (41%). Average patient MPR was 80.3 for brand and 16.7 for generic medicines and was higher for patients in LMICs compared to HUMICs across all medicine categories. The affordability index for brand medicines was 7.7 in LMICs and 4.2 in HUMICs. The affordability index for generic medicines was 2.3 in LMICs and 1.5 in HUMICs.

Conclusions: The cross-country variations in price, availability, and affordability of CVD and hypertension medicines are considerable. Patients in LMICs face higher prices and lower affordability than patients in HUMICs for both brand and generic medicines, though generic medicines are more affordable in all countries. Actions that increase access to medicines can include use of effective generics and efficient procurement mechanisms.