In low-income and middle-income countries these medicines are not widely available and, when available, can often be unaffordable. In rich countries, although such medicines are both available and affordable, 35 percent to 50 percent of patients who have heart disease or a previous stroke still do not receive them. The authors say that a radical shift in how such medicines are provided, and how preventive care is organized in health care systems, is required.
For example, provision of generic versions free of charge in developing countries and provision of medicines by non-physician health workers in all countries are needed to improve rates of use of these medicines, even in the richest countries. The Prospective Urban Rural Epidemiology (PURE) study analyzed data from 18 countries. The World Health Organization (WHO) has proposed that medicines to prevent recurrent cardiovascular disease, including aspirin, Beta blockers, angiotensin-converting-enzyme (ACE) inhibitors, and statins--be available in 80 percent of communities and used by 50 percent of eligible individuals by 2025.
The team of researchers assessed how such low use relates to lack of medicine availability and/or affordability. They analyzed information about availability and costs of cardiovascular disease medicines in pharmacies gathered from 596 communities in 18 countries participating in the PURE study, covering the period 2003-13. Medicines were considered available if present at the pharmacy when surveyed, and affordable if their combined cost was less than 20% of household capacity to pay.
The authors said that given the very large effects of the availability and affordability of medicines on use that they noted, availability and affordability are likely to be essential factors influencing medicine use, unless both availability and affordability of these medicines are improved, their use is likely to remain low in most of the world. They concluded that further research is needed into the development of national regulatory mechanisms for drug pricing, to achieve prices that are closer to drug production costs.
So far, mass antiretroviral treatment for HIV is the one success story. Universal access to medicines will be accelerated through increased health financing and greater availability of low cost medicines targeting major diseases among people with low incomes. The study is published in The Lancet.