Table 1.

Availability and Affordability of cardiovascular medicines

Author and year of publication	Study design	Study setting	Sample size	Type of CV drug (Anti- hypertensive, statins and anti-platelets) studied	Number of CV drugs	Summary of findings
Attaei et al., 2017 [8]	Survey of local pharmacies and households Analysis of The Prospective Urban Rural Epi-demiological (PURE) study: 1st phase	Community pharmacies and households in High income, middle income and low- income countries	16 low- and middle-income countries; 511 communities	Anti-hypertensive and statin only	9	Availability Proportion of communities with four drug classes available was 76% in India (68 of 90), 71% in UMICs (90 of 126), 47% LMICs (107 of 227), and 13% in LICs (nine out of 68) Affordability Proportion of households unable to afford two BP-lowering medicines was 31% in LICs (1069 of 3479 households) and 9% in MICs (5602 of 65 471) Inability to afford two BP medicines plus a statin was 75% in LICs, 22% in lower middle and 26% in UMICs
Ewen et al., 2017 [9]	A facility-based survey using the WHO/HAI methodology	healthcare facilities and pharmacies in low-, lower-middle and upper-middle income countries	2161 outlets in 30 countries	All 3 CV drugs	15	Availability In LICs, median generic availability was 40.2% and 59.1% in the public and private sectors, respectively. Overall generic availability was 54.6% and 65.7% in lower-middle income countries and 56.7% and 76.7% in UMICs in the public and private sectors, respectively Median availability of any product type (originator brands and generics) was 43.3% and 66.7% in the public and private sectors of LICs, respectively. In lower-middle income countries. It was 57.6% and 68.6% in the public and private sectors respectively. In UMICs, median availability was 60.2% in the public sector and 90.0% in the private sector Affordability No more than 1 day’s wage was needed to buy LPG. 1.9 to 3.5 days’ wage was needed to buy originator in public sector Percentage of LPG meeting affordability and availability in the public sector was 11.9%, 33.8% and 34.5% in LI, LMI and UMI countries respectively. It was 22%, 36.7% and 50.9% in the private sector of LI, LMI and UMI countries
Harrison et al., 2021 [10]	Survey of health facilities and patients	Outpatient department of a teaching hospital and two community pharmacies in Ghana	Two health facilities; 304 outpatients; 3 health facilities	Anti-hypertensive drugs only	10	Affordability 74.7% had affordability for four drugs at the public hospital whiles 59.5% of patients could afford 4 drugs at the private pharmacy. 86.2% of patients could afford one BP lowering medicine out-of-pocket at the hospital whiles it was 81.9% at the private pharmacy Availability 15% of patients always obtained all their prescribed anti-hypertensive medication (continuous access) from the hospital pharmacy. Availability was 60%
Van Mourik et al., 2010 [11]	Analysis of data obtained surveys using the WHO/HAI methodology	public and the private health facilities in LI, LMI, UMI and HI countries	45 surveys from 36 countries	Anti-hypertensive medication	5	Availability of CV medicines in LMICs was poor (14.4% to 20.8% for generics in the public sector and 52.3% to 60.1% for generics in the private sector in LMICs). Originator brand availability in public sector was 0.6% to 21.4%) Affordability Average cost in public sector was 2.0 (LPG) and 8.3 (OB) day's wages to purchase one CV medicine for a month. Average affordability was better in the private sector (1.8- and 5.3-day’s wages for the LPG and OB) but the private sector was less affordable if countries were matched
Husain et al., 2020 [13]	Survey of lowest priced generics and originator brands using WHO/HAI survey method; secondary data aggregated at the national level	Public and private health facilities in low-, lower-middle, upper middle- and high-income countries	84 surveys in 59 countries	Anti-hypertensive drugs and statins	9	Availability Average availability was 54% in low- and lower-middle-income countries and 60% in high- and upper-middle-income countries (generic availability—61%; brand availability—41%). Availability of generics was 55% and 67% in public and private sectors respectively Affordability Average costs of 1 month’s antihypertensive medications were 6.0 days’ wage for brand medicine and 1.8 days’ wage for generics. Affordability was lower in low- and lower-middle-income countries than high- and upper-middle-income countries for both brand and generic medication
Chow et al., 2020 [14]	Survey of local pharmacies and households; Analysis of data from The Prospective Urban Rural Epi-demiological (PURE) study	Community pharmacies and households in High income, middle income and low-income countries	17 low- and middle- income countries; 592 communities	All 3 CV drugs	10	Availability CV medicines were not available in 6.9% to 55.8% of communities. Availability of all 3 types of CV drugs (antihypertensive, statin, antiplatelet) in communities in low- and middle-income countries was 50% to 87.2%) Affordability Percentage of High-Risk Adults with All 3 types available and affordable was 37.5% (34,974/93200) at 20% affordability
Ibrahim et al., 2021 [15]	survey using the World Health Organization/Health Action International (WHO/HAI) guideline	Retail medicine outlets in Public Hospitals, Private Hospitals, Private Pharmacies, Public Healthcare Centers	30 facilities	All 3 CV drugs	11	Availability of CV medicines was 27.2% in public hospitals, 6.1% in public health centres and 77.6% for private pharmacies
Kibirige et al., 2017 [17]	WHO and HAI standardised methods-based questionnaire	public hospitals, private hospitals and private pharmacies in 4 regions of Uganda	145 facilities	All 3 CV drugs	28	Availability of CV medicines was 39.4% and 74.1% in the public and private facilities respectively Affordability Less than 1 to 53.5 days’ wages were needed to purchase lowest priced generic drugs in both private hospitals and pharmacies
Argawal et al., 2022 [18]	A cross sectional survey using WHO/HAI methodology	Public and private facilities in low- and middle- income countries	53 low- and middle-income countries	Anti-hypertensive medication	6	Availability was 19.03% to 76.9% for LPG in the public sector. Availability of LPG in the private sector was 41.1% to 80.49% Affordability 0.2 to 3.11 days wages were needed to purchase LPG in the public sector. 0.45 to 3.4 days wages were needed to purchase LPG in the private sector. 2.85 to 7.32 days wages was required to purchase originator drug in public sector
Dzudie et al., 2020 [19]	Survey using the WHO/HAI methodology	public, confessional, private facility medicine outlets, and community pharmacies in Cameroon	63 medicine outlets	All 3 CV drugs	22	Availability was an average of 16.1% in public facility outlets and 16.4% in community pharmacies, being higher in urban and semi-urban compared to rural outlets. Affordability Beta blockers, ACE inhibitors and statins required 2–5 days and 6–13 days wages respectively for one month of chronic treatment. Aspirin, digoxin, furosemide, HCTZ and nifedipine were affordable (cost a day’s wage or less)
Khatib et al., 2016 [20]	Analysis of the Prospective Urban Rural Epi-demiological (PURE) study; survey	Pharmacies and community households	596 communities in 18 countries	All 3 CV drugs	4 classes	Availability CV medicines were available in 80% of urban and 73% of rural communities in UMIC, 62% of urban and 37% of rural communities in LMIC, 25% of urban and 3% of rural communities in LIC (excluding India) Affordability CV medicines were unaffordable for 25% of households in UMIC, 33% of LMIC, 60% of LIC (excluding India