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 Four types of medicines are recommended to help prevent deaths from
cardiovascular disease: aspirin, beta blockers to control heart
rhythm and lower high blood pressure (like atenolol or metoprolol,
for example), drugs such as ACE inhibitors to relax blood vessels
and improve blood flow (like captopril or enalapril, for instance)
and statins to lower cholesterol (such as simvastatin or
atorvastatin, or others).
To assess how easy it might be for people get to all four medicines,
researchers looked at whether local pharmacies stocked all of the
drugs and, if so, whether the combined cost was less than 20 percent
of household income remaining after basic subsistence needs have
been met.
The four medicines were available and affordable in most urban and
rural communities in high-income countries, researchers reported in
The Lancet.
But except for India, all of four drugs were available in low-income
countries in only 25 percent of urban areas and 3 percent of rural
communities.
In addition, these drugs were potentially unaffordable in 60 percent
of low-income countries outside of India.
“The real unaffordability is even worse than what our paper suggests
because it’s not just the pills, it is the amount of time off work,
the cost to see the doctor, and the transportation cost,” said
senior author Salim Yusuf, executive director of the Population
Health Research Institute and professor at McMaster University in
Hamilton, Ontario.
An estimated 17 million people worldwide die of cardiovascular
disease each year, Yusuf and colleagues note.
The World Health Organization wants medicines for preventing
cardiovascular disease to be available in 80 percent of communities
and used by 50 percent of eligible individuals by 2025.
To see how the current reality measures up to this goal, the
research team analyzed data on almost 95,000 households from nearly
600 communities in 18 countries – including about 7,000 people with
cardiovascular disease.
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In upper middle-income countries, the four medicines were available
in 80 percent of urban and 73 percent of rural communities, the
analysis found. But the drugs were unaffordable in 25 percent of
these countries.
For lower middle-income nations, the drugs were all available in 62
percent of urban and 37 percent of rural areas but unaffordable in
one third of the countries.
Access was better in India than in a typical low-income country, the
study found. Here, the medicines were available in 89 percent of
urban and 81 percent of rural communities – and affordable for 59
percent of households.
Louis Niessen and Jahangir Khan, health economists at the Center for
Applied Health Research and Delivery at the Liverpool School of
Tropical Medicine in the U.K., write in an editorial that the
findings highlight a problem that goes far beyond just the
accessibility of medicines for cardiovascular disease.
That’s because families may lose work due to cardiovascular events,
or suffer from additional diseases or injuries that are challenging
to treat due to the cost or the unavailability of care close to
home, they wrote.
“Our failure to provide health care for many leads to a lot of human
suffering and loss of important adults in our lives as they die
prematurely, up to ten to twenty years too early or remain with
disability from stroke or from a more classical tropical condition,”
Niessen said by email.
SOURCE: http://bit.ly/1GSD4G1 The Lancet, online October 20, 2015.
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