Ensuring patient-centered access to cardiovascular disease medicines in low-income and middle-income countries through health-system strengthening

Abstract

Cardiovascular disease (CVD) is the leading cause of global mortality and is expected to reach 23million deaths by 2030.1,2Eighty percent of CV Ddeaths occur in low-income and middle-income countries (LMICs) and predominantly affects a younger population compared with high-income countries (HICs), thus having a significant impact on the economic growth of LMICs.1,3Themortality burden from CVD is projected to increase in LMICs alongside the lifestyle-associated epidemiologic shift favoring noncommunicable disease development.4The associated economic losses are also expected to reach billions of dollars over the next decade, representing yet another barrier to development for LMICs.3Although CVD prevention and treatment guidelines are available, translating these into practice is hampered in LMICs by inadequate health care systems with limited access to potentially lifesaving medications.5Enumerating the barriers to access to CVD medicines requires an examination of both the “policy-level” barriers and “on-the-ground” issues. At the policy level, limited national funding due to competing health priorities, slow incorporation of CVD drugs into the essential medicines list(EML), and structural and financial barriers all limit access to CVD drugs and have been discussed previously with recommendations proposed.6,7Advocacy to create awareness among policymakers on the threat of CVDs to LMIC populations’ health and economic prosperity will increase funding and foster equitable access through inclusion of more CVD drugs into the EML. Overcoming legal barriers in patent law will expedite generic availability to increase affordability with stream-lined global and local procurement practices further bringing down the cost of CVD drugs in the public sector. Finally, engaging the commercial sector so as to regulate markup on CVD drugs will minimize out-of-pocket expenses for patients.6