@article{TEXTUAL,
      recid = {7161},
      author = {Pandey, Kiran Raj and Meltzer, David O.},
      title = {Financial Burden and Impoverishment Due to Cardiovascular  Medications in Low and Middle Income Countries: An  Illustration from India},
      journal = {PLOS ONE},
      address = {2016-05-09},
      number = {TEXTUAL},
      abstract = {&lt;p&gt;Background: Health expenditures are a major financial  burden for many persons in low and middle-income countries,  where individuals often lack health insurance. We estimate  the effect of purchasing cardiovascular medicines on  poverty in low and middle-income populations using rural  and urban India as an example.&lt;/p&gt; &lt;p&gt;Methods: We created  step-up treatment regimens for prevention of ischemic heart  disease for the most common cardiovascular medications in  India based on their cost and relative risk reduction. Cost  was measured by Government of India mandated ceiling prices  in rupees (Rs. 1 = $0·016) for essential medicines plus  taxes. We calculated step-wise projected incidence and  intensity of impoverishment due to medicine purchase. To do  this we measured the resources available to individuals as  daily per-capita expenditures from the latest National  Sample Survey, subtracted daily medication costs, and  compared this to 2014 poverty thresholds recommended by an  expert group.&lt;/p&gt; &lt;p&gt;Findings: Analysis of  cost-effectiveness resulted in five primary prevention drug  regimens, created by progressive addition of Aspirin 75 mg,  Hydrochlorothiazide 12.5mg, Losartan 25 mg, and  Atorvastatin 10 mg or 40mg. Daily cost from steps 1 to 5  increased from Rs. 0·13, Rs. 1.16, Rs. 3.81, Rs. 10.07, to  Rs. 28.85. At baseline, 31% of rural and 27% percent of  urban Indian population are poor at the designated poverty  thresholds. The Rs. 28.85 regimen would be unaffordable to  81% and 58% of rural and urban people. A secondary  prevention regimen with aspirin, hydrochlorothiazide,  atenolol and atorvastatin could be unaffordable to 81% and  57% rural and urban people respectively. According to our  estimates, 17% of the rural 32% of the urban adult  population could benefit with these medications, and their  out of pocket purchase could impoverish 17 million rural  and 10 million urban people in India and increase  respective poverty gaps by 2.9%.&lt;/p&gt; &lt;p&gt;Conclusion:  Medication costs for cardiovascular disease have the  potential to cause financial burden to a significant  proportion of people in India. These costs increase the  likelihood that patients will forego needed treatment and  emphasize the need for programs to reduce the costs of  medications for cardiovascular patients in India, including  by expansion of prescription drug coverage.&lt;/p&gt;},
      url = {http://knowledge.uchicago.edu/record/7161},
}