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Availability, price and affordability of cardiovascular medicines 2001-2006

Availability, price and affordability of cardiovascular medicines 2001-2006. Richard Laing for Alexandra Cameron & Maaike van Mourik International Conference on Improving the Use of Medicines (ICIUM) November 2011. Presentation outline. Introduction & Background Methodology Results

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Availability, price and affordability of cardiovascular medicines 2001-2006

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  1. Availability, price and affordability of cardiovascular medicines 2001-2006 Richard Laing for Alexandra Cameron & Maaike van Mourik International Conference on Improving the Use of Medicines (ICIUM) November 2011

  2. Presentation outline • Introduction & Background • Methodology • Results • Availability • Pricing • Affordability • Conclusions & policy options • Future research agenda

  3. Introduction & Background • Cardiovascular diseases: 30% of deaths worldwide, 80% of which in developing countries • WHO-PREMISE study • Many patients did not get medicines needed for adequate management. • Non-WHO studies • Problems with availability, pricing and affordability • WHO report on chronic disease medicines (30 surveys) • Poor availability and affordability • Aim: Secondary analysis of price, availability and affordability of CVD medicines in 36 developing countries that have undertaken WHO/HAI surveys

  4. Methodology • WHO/HAI data • Standardized data collection • Prices as Median Price Ratios (MPRs) • Medicines: Atenolol 50mg, Captopril 25mg, Hydrochlorothiazide (HCT) 25mg, Losartan 50mg and Nifedipine retard 20mg. • Secondary analysis • Adjustments for inflation and purchasing power • Analysis by World Bank Income Groups and WHO regions.

  5. Country list Low income Chad Ethiopia (2004) Ghana (2004) India-Chennai (2004) India-Haryana (2004) India-Karnataka (2004) India-Maharashtra 12 districts (2004) India-Maharashtra 4 regions (2005) India-Rajasthan (2003) India-West Bengal Kenya (2004) Kyrgyzstan (2005) Mali (2004) Mongolia (2004) Nigeria (2004) Pakistan (2004) Sudan-Gadarif (2006) Sudan-Khartoum (2005) Sudan-Kordofan (2006) Tajikistan (2005) Tanzania (2004) Uganda (2004) Upper-middle income Brazil-Rio de Janeiro (2001) Kazakhstan (2004) Lebanon (2004) Malaysia (2004) South Africa - Kwazulu Natal (2001) High Income Kuwait (2004) United Arab Emirates (2006) p.21 of the report Uzbekistan (2004) Yemen (2006) Lower-middle income Armenia (2001) Cameroon (2002) China-Shandong Province (2004) China-Shanghai (2006) El-Salvador (2006) Fiji (2004) Indonesia (2004) Jordan (2004) Morocco (2004) Peru (2005) Philippines (2005) Sri Lanka (2001) Syria (2003) Tunisia (2004)

  6. Results: Availability (%)

  7. Results: Availability by WBIG

  8. Results: Procurement pricing • Public sector procurement • Procurement vs. public sector patient pricing • Mark-up • Taxes • Procurement at a different price • Cross-subsidizing MPR = 1

  9. Results: Patient pricing Price ratio's in the public & private sector

  10. Results: Patient pricing by WBIG

  11. Results: Private sector brand premiums

  12. Results: Affordability • Number of day's wages the lowest-paid government worker needed to purchase one month of chronic treatment • Large variations, on average 1.8 day's wages for single medicine • Most affordable: atenolol 50mg (1.1 day's wages) • High income areas more affordable than low income • Note: • Average income often below lowest government wage • Need for multiple medicines

  13. Conclusions & policy options • Availability • Focus on small group of medicines from national STG • Increase public sector funding for NCD medicines • Private sector distribution of publicly subsidized medicines • Procurement • Some countries: can improve on procurement prices • Patient prices • Lower taxes & tariffs • Promote the use of generics • Reduce mark-ups

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