Abstract
Objective: This national survey was aimed at measuring the access to cardiovascular disease (CVD) medicines in terms of their availability, price, and affordability in Pakistan. This was done by using the standard WHO/Health Action International (HAI) methodology. Methods: The price and availability data for 18 CVD medicines were collected from public sector hospitals (n = 40) and private sector retail pharmacies (n = 40) in eight cities of Pakistan. The outcome measures were availability (calculated as percentage of health facilities stocked with listed medicines), medicine price to the international reference price ratio (i.e., median price ratio (MPR)), and affordability (calculated as number of days’ wages (NDWs) of the lowest paid unskilled government worker required to afford one-month treatment of a chronic disease). The affordability of standard treatment in Pakistan with four CVD drugs was compared with data from six other low and middle income countries (LMICs) using HAI database. Findings: The mean percent availability of CVD medicines was significantly low (p < 0.001) in the public sector as compared to the private sector, that is, 25.5% vs. 54.6% for originator brands (OBs) and 30.4% vs. 34.9% for lowest price generics (LPGs), respectively. For all OBs and LPGs, the inflation-adjusted mean MPR was 2.72 and 1, respectively. CVD medicines were found to be unaffordable with average NDWs of 6.4 and 2.2 for OBs and LPGs, respectively, that is, NDWs of more than 1. In international comparison with countries such as Sudan, Lebanon, Egypt, India, Afghanistan, and China, the affordability of standard treatment with selected CVD medicines (atenolol, amlodipine, captopril, and simvastatin) in Pakistan was found to be low. Overall, all four OBs and three out of four LPGs of selected CVD drugs were found unaffordable in Pakistan. Conclusion: This data indicated that the availability of selected CVD medicines was low in both public and private sector medicine outlets. Both OBs and LPGs were found unaffordable in the private sector, necessitating the redressal of pricing policies, structuring, and their implementation.
Highlights
Non-communicable diseases (NCDs) have emerged as a leading cause of mortality
The study findings suggested that the availability of cardiovascular diseases (CVDs) medicines was only 62% in urban community (UC) and 37% in rural community (RC) in lower middle income countries, and it was 80% in UC and 73% in RC in upper middle income countries, and it decreased to only 25% in UC and 3% in RC in low income countries
Our study has shown poor availability of CVD medicines in public sector hospitals, forcing the patients to pay out of pocket for the purchase of medicines from private sector retail pharmacies
Summary
Non-communicable diseases (NCDs) have emerged as a leading cause of mortality. These account for approximately 41 million people annually, which is equivalent to 71% of all the deaths worldwide (WHO, 2011). With population of 197 million, Pakistan is the fifth most populous country in the world, and about half of its population is suffering from one or more chronic diseases (Jafar et al, 2013; Population, Pakistan Bureau of Statistics, 2020). The public sector bears 32% of the health expenditures, while 64% is borne by patient’s out of pocket (OOP) payments that may lead to catastrophic consequences for the families (Quick et al, 2002; Hsu et al, 2018; Khan, 2019; Ministry of Finance, Government of Pakistan, 2020). The medicines are provided free of charge, while in private sector hospitals and retail pharmacies the patients have to pay out of pocket to obtain medicines
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