Affordability assessment from a static to dynamic concept: A scenario�based assessment of cardiovascular medicines

Abstract

The out�of�pocket payments for prescription medications can impose a financial burden on patients from low� and middle� incomes and who suffer from chronic diseases. The present study aims at evaluating the affordability of cardiovascular disease (CVD) medication in Iran. This includes measuring affordability through World Health Organization/Health Action International (WHO/HAI) methodology. In this method, affordability is characterized as the number of daysʹ wages of the lowest�paid unskilled government worker. The different medication therapy scenarios are defined in mono�and combination therapy approaches. This method adds on to WHO/HAI methodology to discover new approaches to affordability assessments. The results show the differences in the medicines affordability when different approaches are used in mono�and combination therapy between 6 main sub�therapeutic groups of CVD. It indicates the medicine affordability is not a static concept and it changes dynamically between CVD therapeutic subgroups when it used alone or in combination with other medicines regarding patients� characteristics and medical conditions. Hypertension and anti�arrhythmia therapeutic groups had the most non-affordability and hyperlipidemia had the most affordable medicines. Therefore, affordability can be considered as a dynamic concept, which not only affected by the medicine price but significantly affected by a patient�s characteristics, the number of medical conditions, and insurance coverage. © 2020 by the authors. Licensee MDPI, Basel, Switzerland