Relationship between pharmaceutical pricing strategies with price, availability, and affordability of cardiovascular disease medicines: Surveys in Qatar and Lebanon

Background: Cardiovascular diseases are the leading cause of death in Lebanon and Qatar. When lifestyle modifications prove insufficient, medication becomes a cornerstone in controlling such diseases and saving lives. Price, availability, and affordability hinder the equitable access to medicines. The study aimed to assess prices, availability, and affordability of essential cardiovascular disease medicines in relation to pricing strategies in Qatar and Lebanon. Methods: A cross-sectional survey using a variant of the World Health Organization and Health Action International (WHO/HAI) methodology as outlined in "Measuring medicine prices, availability, affordability and price components" (2008), second edition, was adopted. Prices and availability of 27 cardiovascular medicines were collected from public and private dispensing outlets. For international comparison, prices were adjusted to purchasing power parity. Data was analyzed across multiple sectors, within and across countries. Results: A total of 15 public and private outlets were surveyed in each country. Prices were more uniform in Qatar than in Lebanon. In the public sector, medicines were free-of-charge in Lebanon and priced lower than the international reference prices in Qatar. The ratio of medicine unit price to international reference price in the private sectors surveyed are significantly higher than the acceptable threshold of 4. This ratio of originator brands and lowest priced generics in Qatar were up to two and five times those in Lebanon, respectively, even after adjusting for purchasing power parity. However, prices of lowest priced generics in the private sector were at least 35% cheaper in Qatar and 65% cheaper in Lebanon than their comparative originator brands. Medicines were more available in the private sector in Lebanon than in Qatar, but only the originator brand availability in the public sector in Qatar exceeded the WHO target of more than 80%. While affordable in the public sector in Qatar, four out of thirteen medicines exceeded the threshold in all private sectors covered. Hence, only the public sector in Qatar had a satisfying level of availability and affordability. Conclusions: Except for the Qatari public sector, medicine prices, availability, and affordability are falling short from targets. Key policy decisions should be implemented to improve access to medicines. - 2019 The Author(s).This study was supported by Qatar University with the grants’ numbers (QUST-CPH-SPR-15/16–7 & QUST-CPH-SPR\2017–18). It funded the collection of data and a revision of the written English. The publication fee for this article was funded by the Qatar National Library.Scopu

Access to medicines: Case studies from Russia and Kyrgyzstan

© The Author(s) 2020. We report medicine prices, availability and affordability in Russia and Kyrgyzstan using the WHO/HAI methodology. In Kyrgyzstan, median prices of cardiovascular medicines were 6 times higher than in Russia, whilst their affordability was 9 times lower than in Russia for lowest-priced generics and 11 times lower for originator brands. Antihypertensive pharmacotherapy was affordable in Russia, but not in Kyrgyzstan (2015). We monitored patient and procurement prices in Russia (2010-2017) and documented success of government interventions in reduction of essential and cardiovascular patient prices from 2010 onwards to recommended values for generics in public sector and the need for continued price monitoring

An arterio-venous bridge for gradual weaning from adult veno-arterial extracorporeal life support

Purpose: Weaning from extracorporeal life support (ELS) is particularly challenging when cardiac recovery is slow, largely incomplete and hard to predict. Therefore, we describe an individualized gradual weaning strategy using an arterio-venous (AV) bridge incorporated into the circuit to facilitate weaning. Methods: Thirty adult patients weaned from veno-arterial ELS using an AV bridge were retrospectively analyzed. Serial echocardiography and hemodynamic monitoring were used to assess cardiac recovery and load responsiveness. Upon early signs of myocardial recovery, an AV bridge with an Hoffman clamp was added to the circuit and weaning was initiated. Support flow was reduced stepwise by 10-15% every 2 to 8 hours while the circuit flow was maintained at 3.5-4.5 L/min. Results: The AV bridge facilitated gradual weaning in all 30 patients (median age: 66 [53-71] years; 21 males) over a median period of 25 [8-32] hours, with a median support duration of 96 [31-181] hours. During weaning, the median left ventricular ejection fraction was 25% [15-32] and the median velocity time integral of the aortic valve was 16 cm [10-23]. Through the weaning period, the mean arterial blood pressure was maintained at 70 mmHg and the activated partial thromboplastin time was 60±10 seconds without additional systemic heparinization. Neither macroscopic thrombus formation in the ELS circuit during and after weaning nor clinically relevant thromboembolism was observed. Conclusion: Incorporation of an AV bridge for weaning from veno-arterial ELS is safe and feasible to gradually wean patients with functional cardiac recovery without compromising the circuit integrity. © SAGE Publications