Abstract
Aim. The aim of our study was to continue a comparative analysis of availability and access to cardiovascular medicines in 2017 and 2018 in the city of Kazan according to the original WHO/HAI methodology to assess the effectiveness of government interventions to ensure access to medicines.Material and methods. We performed a comparative analysis of prices of cardiovascular medicines in 2017 and 2018 in Kazan using the World Health Organization and Health Action International (WHO/HAI) methodology, to assess medicines' availability and affordability to ensure their rational use. We studied availability and prices of 71 cardiovascular medicines in public and private pharmacies in the city of Kazan and analyzed procurement prices of these medicines in hospitals. Also we studied the affordability of medicines, as well as performed pharmacoeconomic cost-minimization analysis for arterial hypertension pharmacotherapy in 2018. For each name, we studied the prices for the original brand and its lowest-priced generic. We compared medicine prices with international reference, delivered by the Management Sciences for Health and by expressing them as median price ratio (MPR).Results. In the public sector, prices of generic medicines were at the level of reference prices with the indicators of MPR 1.14 [0.41-1.84] and 1.17 [0.49-2.21], in 2017 and 2018 respectively. In the private sector, prices of generics reduced 2 times in 2018 compared to 2017, with the decrease in MPR from 2.22 [1.12-3.91] to 1.25 [0.44-2.32], (p<0.05). In the public sector, the affordability indicators of generics were the same in the studied years (Me=0.24 in 2017 and Me=0.26 in 2018). However, in the private sector there was a 2.5 times reduction in the affordability of generics (reduction Me from 0.66 to 0.24, p<0.05) in 2018 compared to 2017. From 2017 to 2018 the affordability of original brands changed from 1.9 to 1.3 in the public sector and from 2.3 to 1.5 in the private sector, but this change was not statistically significant (p>0.05). In 2018, depending on the choice of the medicine the annual course of therapy of hypertension varied from 149 to 28835 rubles.Conclusions. In 2018, the prices of generic cardiovascular medicines, but not of originator brands, reached the level of reference prices in both the public and private sectors of Kazan. According to the WHO/HAI methodology, generic cardiovascular medicines became affordable. In the private sector, there was a reduction in the prices of generic medicines, but not of originator brands, with an improvement of affordability of generics in 2018 compared to 2017.
Highlights
We studied availability and prices of 71 cardiovascular medicines in public and private pharmacies in the city of Kazan and analyzed procurement prices of these medicines in hospitals
We studied the affordability of medicines, as well as performed pharmacoeconomic cost-minimization analysis for arterial hypertension pharmacotherapy in 2018
В соответствии со стандартной методологией Всемирной организации здравоохранения (ВОЗ)/HAI [5] доступность 30-дневного стандартного курса лечения артериальной гипертензии (АГ) [13] рассчитали, используя дневную заработную плату самого низкооплачиваемого неквалифицированного государственного служащего, и выразили результаты как число оплачиваемых рабочих дней, необходимых для покрытия расходов на лечение
Summary
Выбор лекарств мы осуществили по алгоритму разработки перечня лекарственных средств для исследования, как описано в нашей первоначальной статье [8]. Согласно методологии ВОЗ/HAI регистрировали цены на лекарственные препараты в местных денежных единицах (рубли) и представляли в виде медиан отношения цен к референтным ценам (МОЦР). В соответствии со стандартной методологией ВОЗ/HAI [5] доступность 30-дневного стандартного курса лечения артериальной гипертензии (АГ) [13] рассчитали, используя дневную заработную плату самого низкооплачиваемого неквалифицированного государственного служащего (минимальный размер оплаты труда, МРОТ), и выразили результаты как число оплачиваемых рабочих дней, необходимых для покрытия расходов на лечение. Медиана отношения цен к референтным: сравнение конечных цен для потребителя в государственном секторе с международными референтными ценами. Медиана отношения цен к референтным: сравнение конечных цен для потребителя в частном секторе с международными референтными ценами. Цены на дженерики закупленных для стационаров лекарств были на уровне референтных цен и являлись приемлемыми согласно методологии ВОЗ/HAI, однако цены на оригинальные бренды были высокими и превышали референтные цены почти в 9 раз
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