Heart failure & cardiomyopathies
Pharmaco-Disparities in Heart Failure: A Survey of the Affordability of Guideline Recommended Therapy in 10 Countries
Authors' conclusion
There was marked variation between countries in the retail price of HFrEF GDMT. Despite higher prices in high-income countries, GDMT was more accessible and affordable than in low- and middle-income countries. Publicly funded drug programmes in lower income countries increased affordability but limited access to newer HFrEF GDMT classes.
Study context
- Population
- Online or community pharmacies in 10 countries across World Bank income groups; Heart failure with reduced ejection fraction (HFrEF) guideline-directed medical therapy (GDMT) (angiotensin-converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB)/ARNI, beta-blockers, mineralocorticoid receptor antagonists (MRA), SGLT2i)
- Participants
- 10 countries
- Outcome
- Price, affordability (relative to gross national income per capita per month) and accessibility of HFrEF GDMT
- Follow-up
- Mean 30 day retail prescription
Methodological detailssurvey, 10 countries, literature review of public drug programmes
- Survey
- 10 countries
- Literature review of public drug programmes
Main finding
As reported in the abstract
Price, affordability and access of HFrEF GDMT · mean 30 day
- Sacubitril/valsartan (ARNI), most expensive, mean (SD) 30 day price, Pakistan
- $11.06 (0.81)
- Sacubitril/valsartan (ARNI), mean (SD) 30 day price, US
- $611.50 (3.54)
- Spironolactone (MRA), least expensive, mean (SD) 30 day price, Pakistan
- $0.18 (0.00)
- Spironolactone (MRA), mean (SD) 30 day price, England
- $12.32 (0.00)
- Affordability (SD) of quadruple therapy, % of gross national income per capita per month, England (best)
- 1.49 (0.00)%
- Affordability (SD) of quadruple therapy, % of gross national income per capita per month, Uganda (worst)
- 232.47 (31.47)%
Observational data: associations, not effects.
Original publication
Pharmaco-Disparities in Heart Failure: A Survey of the Affordability of Guideline Recommended Therapy in 10 Countries. ESC Heart Fail. Published 30 August 2023. doi:10.
Summarised from the published abstract; every number is checked against it