Developing Countries Gain More Access to Cardiovascular Meds

The last decade saw middle-income countries enjoying improved access to cardiovascular medications, but they remain far from closing the considerable gap with richer countries.

Cardiovascular drug sales grew about 10 times faster from 2008 to 2018 in middle-income countries than in high-income countries (annual growth rate 9.96% vs 0.98%), according to a large pharmaceutical sales database probed by Esther Chan, PhD, of the University of Hong Kong, and colleagues.

As a result, the 15-fold gap in total cardiovascular medicine sales between the two country types in 2008 (27.69 vs 410.54 defined daily doses per 1,000 inhabitants per day) shrank to a six-fold gap in 2018 (71.57 vs 452.52 defined daily doses per 1,000 inhabitants per day), reported Chan’s group in the February 23 issue of the Journal of the American College of Cardiology.

It is a “pleasant surprise” that medication consumption is going up in these countries, commented Thomas Gaziano, MD, MSc, of Brigham and Women’s Hospital and Harvard Medical School in Boston. “It’s unfortunate to see middle-income countries not getting as much care as they could, and not surprising, but it’s reassuring that they are seeing an increase in growth to correct the problem,” he said in an interview.

Study authors urged additional efforts to improve access to cardiovascular medicines, particularly in middle-income countries, in order to reach the WHO Global Action Plan goal of having at least 50% of eligible people on drug therapy and counseling for the prevention of MI and stroke by 2025.

The study was based on aggregated pharmaceutical sales data, a proxy for cardiovascular medication consumption, from the IQVIA Multinational Integrated Data Analysis System. Data were collected from 65 countries: 38 high-income countries and 27 middle-income countries according to 2018 World Bank income classification.

Across the 65 countries, consumption of all cardiovascular drugs increased from 113.58 to 153.52 defined daily doses per 1,000 inhabitants per day over the study period — reflecting a 3.06% annual growth that outpaced the estimated 2.5% annual increase in global prevalence of cardiovascular disease.

The chief limitations of the retrospective study were the lack of patient-level data and the exclusion of low-income countries, Chan and colleagues acknowledged. Sales projections had also been applied to countries with limited raw data in the IQVIA database.

Chan’s group noted that the prevalence of cardiovascular disease was only two-fold higher in high-income countries versus middle-income countries, suggesting that other factors were contributing to reduced medication consumption in the latter.

“Our results supported previous findings that country income influences use of cardiovascular medicines more than patient-based factors such as age, sex, body mass index, and hypertension,” the authors concluded.

Roadblocks to getting cardiovascular medications to eligible patients can be attributed to various systems-related issues in each given country — some financial, some logistical, and some related to recognition of the problem, Gaziano said.

For example, a country needs to have the ability to screen for risk factors and have a capable workforce to do the screening. On top of that, providers have to be willing to prescribe medication once risk is detected, and then the medication has to make it through the supply chain to be available in that country.

Finally, Gaziano said there is the patient-level issue of whether patients pick up their prescribed medications.