Table.
Presence on National Essential Medicines Lists, Availability, Price, and Affordability of Guideline-Directed Medical Therapy for Patients With Heart Failure With Reduced Ejection Fraction
| Presence on National EML* N=53 (%) | Availability† (% of facilities; n=no. of surveys) | Patient price‡ MPR (n=no. of surveys) | Procurement price‡ MPR (n=no. of surveys) | Affordability,§ no. of days of income (n=no. of surveys) | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Originator brand | Lowest price generic | Originator brand | Lowest price generic | Originator brand | Lowest price generic | Originator brand | Lowest price generic | ||||||||
| Public | Private | Public | Private | Public | Private | Public | Private | Public | Private | Public | Private | ||||
| ACE inhibitor or ARB | |||||||||||||||
| Enalapril 10 mg | 37 (69.8) | 7.44 (n=15) | 22.40 (n=16) | 59.23 (n=18) | 80.49 (n=19) | 23.95 (n=4) | 104.61 (n=7) | 8.09 (n=17) | 24.99 (n=19) | 15.02 (n=3) | 1.65 (n=12) | 2.85 (n=2) | 4.83 (n=7) | 1.24 (n=7) | 1.47 (n=13) |
| Losartan 50 mg | ∥ | 6.98 (n=11) | 38.50 (n=11) | 53.69 (n=12) | 77.00 (n=12) | 74.32 (n=11) | 293.94 (n=27) | 56.41 (n=14) | 110.38 (n=33) | 3.52 (n=9) | 1.18 (n=9) | 7.32 (n=6) | 9.34 (n=8) | 3.11 (n=8) | 3.40 (n=12) |
| β-Blocker | |||||||||||||||
| Carvedilol 25 mg | 22 (41.5) | 2.85 (n=2) | 76.65 (n=2) | 19.03 (n=3) | 41.10 (n=3) | 0.00 (n=1) | 24.62 (n=3) | 0.00 (n=2) | 15.81 (n=3) | 2.12 (n=1) | 1.14 (n=3) | ∥ | ∥ | ∥ | ∥ |
| Metoprolol 100 mg | 17 (32.1) | 0.00 (n=1) | 13.30 (n=1) | 76.90 (n=1) | 66.70 (n=1) | ∥ | ∥ | ∥ | ∥ | ∥ | ∥ | ∥ | ∥ | ∥ | ∥ |
| Mineralocorticoid receptor antagonist | |||||||||||||||
| Spironolactone 25 mg | 47 (88.7) | 15.70 (n=2) | 38.35 (n=2) | 68.57 (n=3) | 59.33 (n=3) | 0.00 (n=1) | 13.90 (n=1) | 1.21 (n=4) | 3.91 (n=3) | 2.67 (n=1) | 1.02 (n=3) | ∥ | ∥ | ∥ | ∥ |
| Loop diuretic | |||||||||||||||
| Furose-mide 40 mg | 50 (94.3) | 7.34 (n=19) | 50.31 (n=20) | 71.36 (n=29) | 76.29 (n=30) | 10.42 (n=4) | 68.02 (n=33) | 3.99 (n=40) | 11.52 (n=43) | 6.28 (n=4) | 1.74 (n=36) | ∥ | ∥ | 0.20 (n=1) | 0.45 (n=2) |
Prices are in MPR to international reference prices, and all MPRs were converted into a base year (2013). Countries included in the WHO/HAI survey analysis of availability, price, and affordability: Afghanistan, Armenia, Bolivia, Brazil, Burkina Faso, Burundi, China, Colombia, Congo, Democratic Republic of Congo, Ecuador, Egypt, El Salvador, Ethiopia, Fiji, Ghana, Haiti, India, Indonesia, Iran, Jordan, Kazakhstan, Kenya, Kuwait, Kyrgyzstan, Lao PDR, Lebanon, Malaysia, Mali, Mauritius, Mexico, Moldova, Mongolia, Morocco, Nicaragua, Nigeria, Oman, Pakistan, Peru, Philippines, Russia, Sao Tome en Principe, Saudi Arabia, South Africa, Sri Lanka, Sudan, Syria, Tajikistan, Tanzania, Thailand, Tunisia, Uganda, Ukraine, United Arab Emirates, Uzbekistan, and Yemen. ACE indicates angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; EML, essential medicines list; MPR, median price ratio; and WHO/HAI, World Health Organization/Health Action International.
Presence on national EML is defined as the inclusion of the specific drug (irrespective of drug dose specified) in the number of national EMLs of the countries included in this analysis: Afghanistan (EML year 2007), Algeria (2006), Angola (2008), Bhutan (2012), Botswana (2012), Burundi (2012), Central African Republic (2009), Chad (2007), Congo (2013), Cote d’Ivoire, Democratic Republic of Congo (2010), Djibouti (2007), Egypt (2006), Eritrea (2010), Ethiopia (2015), Ghana (2010), Guyana (2010), Haiti (2012), Honduras (2011), India (2011), Indonesia (2008), Iran (2009), Kenya (2016), Lebanon (2010), Lesotho (2005), Malaysia (2008), Mali (2008), Mauritania (2007), Mexico (2009), Morocco (2008), Myanmar, Namibia (2008), Nepal (2009), Nigeria (2010), Oman (2009), Pakistan (2007), Paraguay (2009), Peru (2010), Philippines (2008), Rwanda (2010), Senegal (2008), Somalia (2006), South Africa (2014), Sri Lanka (2009), Sudan (2007), Tanzania (2013), Thailand (2012), Timor-Leste (2004), Togo (2012), Tunisia (2008), Uganda (2007), and Zambia (2013).
Availability is defined as the percentage of facilities in which a particular medicine was available at the time of the survey. The availability of medicines corresponding to the exact forms and strengths are reported. The availability data refer to the day of data collection at each particular facility and may not reflect the average monthly or yearly availability of medicines at individual facilities. The data, survey methodology, and definitions are available on the Health Action International website (https://haiweb.org/what-we-do/price-availability-affordability/collecting-evidence-on-medicine-prices-availability/).
The median price data collected in the surveys are expressed as a summary measure in relation to a standard set of reference prices, defined as the MPR, which facilitates national and international comparisons. The medicine and dose-specific international reference prices are taken from the Management Sciences for Health International Drug Price Indicator Guide, which represents the median procurement prices offered by both not-for-profit and for-profit suppliers to low- and middle-income countries for multisource products. Prices are reported as MPR. The MPR is calculated as the median local unit price divided by the international unit reference price in local currency using the exchange rate on the first day of data collection. We report prices for (1) public-sector procurement, representing prices that the government and other purchasers pay to procure medicines, generally through a tendering process; (2) patient prices in the public sector that patients must pay in government, municipality, or other local authority health facilities, including clinics and hospitals, health centers, and pharmacies; and (3) patient prices in the private sector that patients pay in retail pharmacies and pharmacies in private clinics and hospitals. In countries where patients have a free provision of a medicine, the patient prices were assumed to be 0.
Affordability is measured by the patient cost of medicines relative to an income measure, which the WHO/HAI methodology defines as the daily wage of the lowest paid unskilled government worker in each country. Affordability is expressed as the number of days the lowest paid unskilled government worker would have to work to afford the cost of 30 days of medication.
Insufficient data available.