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
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
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DOI：
10.1016/s0140-6736(15)00469-9
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发表时间：
2016-01-02
期刊：
影响因子：
168.9
通讯作者：
Yusuf, Salim
中科院分区：
文献类型：
--
作者：
Khatib, Rasha;Mckee, Martin;Yusuf, Salim
背景世卫组织的目标是，到2025年，80%的社区可以获得预防心血管疾病复发的药物，50%的符合条件的个人使用药物。我们以前曾报道过这些药物的使用率非常低，但现在的目标是评估这种低使用率与缺乏可获得性或负担不起之间的关系。方法我们分析了参与前瞻性城乡流行病学(PRIME)研究的18个国家596个社区的药店中关于心血管疾病药物(阿司匹林、β受体阻滞剂、血管紧张素转换酶抑制剂和他汀类药物)的可获得性和成本的信息。在接受调查时，如果药房有药品，就被认为是可用的，如果它们的总成本低于家庭支付能力的20%，就被认为是可以获得的。我们比较了高收入、高中等收入、低中等收入和低收入国家的结果。鉴于印度庞大的仿制药行业，来自印度的数据是单独提供的。发现社区是在2003年1月1日至2013年12月31日之间招募的。所有四种心血管疾病药物在高收入国家城市社区的61个(95%)和农村30个社区的27个(90%)、高中等收入国家66个城市社区的53个(80%)和农村59个社区中的43个(73%)可获得，中低收入国家111个城市社区中的69个(62%)和114个农村社区中的42个(37%)可获得所有四种心血管疾病药物，低收入国家(不包括印度)32个城市社区中的8个(25%)和30个农村社区中的1个(3%)以及印度38个城市社区中的34个(89%)和52个农村社区中的42个(81%)可获得所有四种心血管疾病药物。对于高收入国家0.14%的家庭(9934户家庭中的14户)、25%的高中等收入国家(24776户中的6299户)、33%的中低收入国家(40023户中的13253户)、60%的低收入国家(不包括印度；1976年的3312年)和印度59%的家庭(16874户中的9939户)来说，这四种心血管疾病药物可能负担不起。在低收入和中等收入国家，如果可用药物少于四种，有心血管疾病史的患者使用所有四种药物的可能性较小(优势比[OR]0.16，95%可信区间0.04-0.57)。在所有四种药物都有的社区，如果家庭可能买不起药物，患者就不太可能使用药物(0.16，0.04-0.55)。解释二级预防药物对于高中等收入、低中等收入和低收入国家的很大比例的社区和家庭来说是无法获得和无法解决的，因为这些药物的使用率很低。改善关键药物的可获得性和可控性可能会增加它们的使用，并有助于实现世卫组织到2025年使用50%关键药物的目标。
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, beta 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 aff ordable 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 unaff ordable 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 aff ordability of key medicines is likely to enhance their use and help towards achieving WHO's targets of 50% use of key medicines by 2025.