FINANCIAL BURDEN AND IMPOVERISHMENT DUE TO CARDIOVASCULAR MEDICINES IN LOW AND MIDDLE INCOME COUNTRIES, AN ANALYSIS WITH ILLUSTRATION FROM INDIA

Purpose:

Health expenditures are a major reason for financial burden in low and middle income countries as these countries often lack health insurance. With the increasing incidence of non-communicable diseases, this trend is likely to worsen. We estimate the effect on poverty of purchasing cardiovascular medicines in India.

Method:

We created a treatment ladder of cardiovascular medicines with an Aspirin, Atenolol, Atorvastatin, Losartan and Hydrochlorothiazide to reflect a step-up therapy approach for cardiovascular diseases. Drug prices were Government of India mandated ceiling prices for essential medicines plus taxes. Daily per-capita expenditures obtained from the latest National Sample Survey were used as a measure of available resource. Poverty thresholds were used as set by the Planning Commission in 2013. We calculated step-wise projected incidence and intensity of impoverishment due to medicine purchase.

Result:

Daily cost of medicines at Step 1 was ₹0·13 (₹1=$0·016) with Aspirin 75 mg, in Step 2 it was ₹2·32 with addition of Atenolol 50mg, ₹8·88 in Step 3 with the addition of 10 mg of Atorvastatin, ₹11·53 in Step 4 with Losartan 25 mg and ₹12·56 in Step 5 with addition of Hydrochlorothiazide 12·5 mg. 22·7% of rural and 14·3% percent of urban Indian population is poor at the designated poverty thresholds. The need to purchase Step 2 medicines would impoverish an additional 4.7% rural and 3.3% urban population; poverty gaps would increase by 0.64% and 0.17% respectively. At step 5 the poverty ratios would increase by 36% and 15.8%; poverty gap increase would be 15% and 7.9%. Using higher doses of Atenolol, Losartan and Atorvastatin in Step 5 would increase the poverty ratios by 63.1% and 40.8%. ·

Conclusion:

Medication costs have the potential to cause impoverishment in a significant proportion of people in India. As cardiovascular disease prevalence increases, such costs are likely to be a major reason for impoverishment.