Journal
LANCET
Volume 387, Issue 10013, Pages 61-69Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/S0140-6736(15)00469-9
Keywords
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Categories
Funding
- Population Health Research Institute
- Canadian Institutes of Health Research
- Heart and Stroke Foundation of Ontario (Canada)
- Boehringer Ingelheim (Germany)
- Boehringer Ingelheim (Canada)
- AstraZeneca (Canada)
- Sanofi - Aventis (France)
- Sanofi - Aventis (Canada)
- Servier
- GlaxoSmithKline (GSK)
- Novartis
- King Pharma
- Independent University, Bangladesh
- Mitra and Associates
- Unilever Health Institute, Brazil
- Public Health Agency of Canada
- Champlain Cardiovascular Disease Prevention Network
- Universidad de la Frontera
- National Centre for Cardiovascular Diseases
- Colciencias [6566-04-18062]
- Indian Council of Medical Research
- Ministry of Science, Technology and Innovation of Malaysia [100-IRDC/BIOTEK 16/6/21 [13/2007], 07-05-IFN-MEB010]
- Ministry of Higher Education of Malaysia [600-RMI/LRGS/5/3 [2/2011]]
- Universiti Teknologi MARA
- Universiti Kebangsaan Malaysia [UKM-Hejim-Komuniti-15-2010]
- Occupied Palestinian territory-the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), occupied Palestinian territory
- International Development Research Centre (IDRC), Canada
- Polish Ministry of Science and Higher Education [290/W-PURE/2008/0]
- Wroclaw Medical University
- The North-West University
- SANPAD (South Africa and Netherlands Programme for Alternative Development)
- National Research Foundation
- Medical Research Council of South Africa
- South African Sugar Association (SASA)
- Faculty of Community and Health Sciences (UWC)
- AFA Insurance
- Swedish Council for Working Life and Social Research
- Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning
- Swedish Heart and Lung Foundation
- Swedish Research Council
- Swedish State under LakarUtbildningsAvtalet
- Vastra Gotaland Region (FOUU)
- Metabolic Syndrome Society
- AstraZeneca, Turkey
- Sanofi - Aventis, Turkey
- Sheikh Hamdan Bin Rashid Al Maktoum Award For Medical Sciences, Dubai Health Authority, Dubai United Arab Emirates
- Australian National Health and Medical Research Council Career Development Fellowship
- National Heart Foundation
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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.
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