Karim J Gebran-Chedid, Diana De Oliveira-Gomes, Gabriela Lombardo, Maria Carolina Bacci-Padron, David A Forero-Peña
{"title":"Price and Affordability of Heart Failure Guideline Directed Medical Therapy in Venezuela: A Cross Sectional Observational Study.","authors":"Karim J Gebran-Chedid, Diana De Oliveira-Gomes, Gabriela Lombardo, Maria Carolina Bacci-Padron, David A Forero-Peña","doi":"10.5334/gh.1474","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) impacts over 56 million people worldwide, with significantly higher mortality rates in low and low-middle-income countries (LIC/LMICs). Despite the effectiveness of guideline-directed medical therapy (GDMT) for HF with reduced ejection fraction (HFrEF), its use remains limited in LIC/LMICs due to limited availability and affordability. These barriers are particularly pressing in Venezuela's context, as the country faces an ongoing crisis.</p><p><strong>Objective: </strong>Describe price and affordability of HF Guideline Directed Medical Therapy at optimal dosages in Venezuela.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis from December 2023 to January 2024, surveying prices of HF GDMT medications across 13 major pharmacy networks in Venezuela. Medications analyzed included ACE inhibitors (ACEi), angiotensin receptor blockers (ARB), beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), angiotensin receptor-neprilysin inhibitors (ARNI), and sodium-glucose co-transporter 2 inhibitors (SGLT2i). Affordability was defined and calculated using the World Health Organization/Health Action International (WHO/HAI) methodology, comparing the median costs of one month of HF GDMT at optimal dosages to the lowest-paid government worker's (LPGW) daily wages. Other comparisons of price affordability were made against the mean daily salary of managers, professional and non-professional workers in the country.</p><p><strong>Results: </strong>The most expensive medication regime for HF in Venezuela was ARNI-based GDMT with a median monthly cost of 393.81USD, followed by ARB-based GDMT and ACEi-based GDMT costing $100.88USD and $82.23USD respectively. meaning LPGW and elderly receiving retirement stipends would need between 506 to 2421 paid work days to cover one month of treatment at optimal dosages.</p><p><strong>Conclusion: </strong>Based on the WHO/HAI methodology all HF GDMT regimens were deemed unaffordable in Venezuela. Similar affordability challenges exist in other LIC/LMICs countries highlighting the need for global advocacy and policy action to address financial barriers to access guideline-based heart failure care.</p>","PeriodicalId":56018,"journal":{"name":"Global Heart","volume":"20 1","pages":"89"},"PeriodicalIF":3.1000,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12513341/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Global Heart","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5334/gh.1474","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Heart failure (HF) impacts over 56 million people worldwide, with significantly higher mortality rates in low and low-middle-income countries (LIC/LMICs). Despite the effectiveness of guideline-directed medical therapy (GDMT) for HF with reduced ejection fraction (HFrEF), its use remains limited in LIC/LMICs due to limited availability and affordability. These barriers are particularly pressing in Venezuela's context, as the country faces an ongoing crisis.
Objective: Describe price and affordability of HF Guideline Directed Medical Therapy at optimal dosages in Venezuela.
Methods: We conducted a cross-sectional analysis from December 2023 to January 2024, surveying prices of HF GDMT medications across 13 major pharmacy networks in Venezuela. Medications analyzed included ACE inhibitors (ACEi), angiotensin receptor blockers (ARB), beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), angiotensin receptor-neprilysin inhibitors (ARNI), and sodium-glucose co-transporter 2 inhibitors (SGLT2i). Affordability was defined and calculated using the World Health Organization/Health Action International (WHO/HAI) methodology, comparing the median costs of one month of HF GDMT at optimal dosages to the lowest-paid government worker's (LPGW) daily wages. Other comparisons of price affordability were made against the mean daily salary of managers, professional and non-professional workers in the country.
Results: The most expensive medication regime for HF in Venezuela was ARNI-based GDMT with a median monthly cost of 393.81USD, followed by ARB-based GDMT and ACEi-based GDMT costing $100.88USD and $82.23USD respectively. meaning LPGW and elderly receiving retirement stipends would need between 506 to 2421 paid work days to cover one month of treatment at optimal dosages.
Conclusion: Based on the WHO/HAI methodology all HF GDMT regimens were deemed unaffordable in Venezuela. Similar affordability challenges exist in other LIC/LMICs countries highlighting the need for global advocacy and policy action to address financial barriers to access guideline-based heart failure care.
Global HeartMedicine-Cardiology and Cardiovascular Medicine
CiteScore
5.70
自引率
5.40%
发文量
77
审稿时长
5 weeks
期刊介绍:
Global Heart offers a forum for dialogue and education on research, developments, trends, solutions and public health programs related to the prevention and control of cardiovascular diseases (CVDs) worldwide, with a special focus on low- and middle-income countries (LMICs). Manuscripts should address not only the extent or epidemiology of the problem, but also describe interventions to effectively control and prevent CVDs and the underlying factors. The emphasis should be on approaches applicable in settings with limited resources.
Economic evaluations of successful interventions are particularly welcome. We will also consider negative findings if important. While reports of hospital or clinic-based treatments are not excluded, particularly if they have broad implications for cost-effective disease control or prevention, we give priority to papers addressing community-based activities. We encourage submissions on cardiovascular surveillance and health policies, professional education, ethical issues and technological innovations related to prevention.
Global Heart is particularly interested in publishing data from updated national or regional demographic health surveys, World Health Organization or Global Burden of Disease data, large clinical disease databases or registries. Systematic reviews or meta-analyses on globally relevant topics are welcome. We will also consider clinical research that has special relevance to LMICs, e.g. using validated instruments to assess health-related quality-of-life in patients from LMICs, innovative diagnostic-therapeutic applications, real-world effectiveness clinical trials, research methods (innovative methodologic papers, with emphasis on low-cost research methods or novel application of methods in low resource settings), and papers pertaining to cardiovascular health promotion and policy (quantitative evaluation of health programs.