Cardiovascular medicine prices as an indicator of access to medicines and their rational use

Aim. To perform a comparative analysis of cardiovascular medicine prices in 2011 and 2015 and to assess their availability and affordability as a basis for rational pharmacotherapy.

Material and methods. We conducted a comparative analysis of prices for cardiovascular medicines in 2011 and 201 5 in Kazan using the World Health Organization and Health Action International (WHO/HAI) methodology, to assess medicines' availability and affordability to ensure their rational use. We studied availability and prices of 71 cardiovascular medicines in public and private pharmacies of the city of Kazan and analyzed procurement prices of these medicines in hospitals. Also we performed pharmacoeconomic cost-minimisation analysis for arterial hypertension pharmacotherapy in 2015. For each medicine, we analyzed the prices for the original brand drug and its lowest-priced generic. We compared medicine prices with international reference prices of 201 0 and 201 5, delivered by the Management Sciences for Health, by expressing them as median price ratio. Recording and analysis were performed using the standardized MS Excel WHO/HAI Workbook.

Results. The prices of generic medicines, both in the public and private sectors, decreased relative to reference prices in 2015 compared to 2011. In 201 1 one third of the medicines were purchased as original brands and in 201 5 almost all medicines were procured as generics with a fourfold decrease in prices. In 201 5, depending on the choice of the medicine the annual course of monotherapy of hypertension varied from 208 to 281 05 rubles.

Conclusion. Over the five years from 2011 to 2015, there was a general trend of price reduction for generic products relative to reference prices for cardiovascular medicines. But in order to provide rational pharmacotherapy, additional price studies and pharmacoeconomic analyzes are needed, taking into account the changing prices on the pharmaceutical market.

1. Cameron А.М., Ewen M., Ross-Degnan D., et al. Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis. Lancet. 2009; 373(9659):240-9. doi:10.1016/S0140-6736(08)61762-6.

2. Gunther G., Gomez GB., Lange C. et al. Availability, price and affordability of anti-tuberculosis drugs in Europe: a TBNET survey. Eur Respir J. 2015;45(4):1081 -88. doi:10.1183/09031936.00124614.

3. Gong S., Wang Y, Pan X., Zhang L. et al. The availability and affordability of orphan drugs for rare diseases in China. Orphanet J Rare Dis. 2016;11:20. doi:10.1186/s13023-016-0392-4.

4. Babar Z.U., Ibrahim M.I., Singh H. et al. Evaluating Drug Prices, Availability, Affordability, and Price Components: Implications for Access to Drugs in Malaysia. PLoS Med. 2007;4(3):82. doi:10.1371/journal.pmed.0040082.

5. Sharma A., Rorden L., Ewen M. et al. Evaluating availability and price of essential medicines in Boston area (Massachusetts, USA) using WHO/HAI methodology. J Pharm Policy Pract. 2016; 9:12. doi:10.1186/s40545-016-0059-5.

6. Wirz VJ., Hogerzeil H.V., Gray A.L. et al. (the Lancet Commission on Essential Medicines) Essential medicines for universal health coverage. Lancet. 2016;389(10067):403-76. doi:10.1016/S0140-6736(16)31599-9.

7. Decree of the Government of Russia of February 17, 2011 No. 91 "On the federal target program "Development of the pharmaceutical and medical industry of the Russian Federation for the period up to 2020 and beyond". (In Russ.)

8. Medicine Prices, Availability, Affordability & Price Components Database Health Action International. [cited by July 9, 2017]. Available from: www.haiweb.org/what-we-do/price-availability-affordabil-ity/price-availability-data.

9. Khatib R., McKee M., Shannon H., et al. Availability and affordability of cardiovascular disease medicines and their effect on use in high-income, middle-income, and low-income countries: an analysis of the PURE study data. Lancet. 2016;387(10013):61-9. doi:10.1016/S0140-6736(15)00469-9.

10. On World Heart Day WHO calls for accelerated action to prevent the world's leading global killer. World Health Organization/Ca rdiovascular diseases (CVDs). [cited by July 9, 2017]. Available from: www.who.int/cardiovascular_diseases/en/.

11. Razzakova Ch.M., Ziganshina L.E. Change in in affordability of medication in Kazan in 2011 and 2015 as a reflection of state initiatives to regulate drug prices. Kazan Medical Journal. 2017 ;5:822-6.

12. Imaeva A.E., Balanova YA., Kontsevaya A.V., et al. Availability and Affordability of Medicines for the Treatment of Cardiovascular Diseases in Pharmacies in Six Regions of the Russian Federation. Rational Pharmacotherapy in Cardiology, 2018;1 4(6):804-1 5. (In Russ.) doi:10.20996/1819-6446-2018-14-6-804-815].

13. Order of the Government of the Russian Federation of October 23, 201 7. No. 2323-p "List of vital and essential drugs for medical use for 2018". (In Russ.)

14. Jagudina R.I., Serpik V.G. Cost analysis methodology Pharmacoeconomics: Theory and Prac-tice.2016;4(2):5-9. (In Russ.)

15. 2013 Russian clinical guidelines for the diagnosis and treatment of arterial hypertension [cited by 21.04.2019]. Available from: http://www.gipertonik.ru/files/any/recommendations_ag_2013.doc (In Russ.)

16. Federal Antimonopoly Service, Department of Social Control and Trade. Tie results of the evaluation of the availability of drugs based on the analysis of consumer prices and pricing of drugs in the Russian Federation (including in the context of the subjects of the Russian Federation) and in comparable markets of countries including the CIS countries, the European Union and BRICS. [cited by 21.04.201 9]. Available from: http://spb.fas.gov.ru/sites/spb.fusfb.ru/files/analytic/2014/02/18/doklad_po_cenam_na_lekarstva.pdf. (In Russ.)

17. Wirtz V.J., Hogerzeil H.V, Gray A.L., et al. Essential medicines for universal health coverage. Lancet. 2017;389(10067):403-76. doi:10.1016/S0140-6736(16)31599-9.