AVAILABILITY, PRICES, AND AFFORDABILITY OF ESSENTIAL MEDICINES FOR CARDIOVASCULAR DISEASES AND DIABETES: A MULTI-REGIONAL SURVEY ACROSS PAKISTAN
Author(s)
Muhammad Uzair ul Haq, PharmD1, Amjad Khan, PhD2, Saima Mushtaq, PhD3, Yu Fang, PhD4;
1Quaid-i-Azam University, Department of Pharmacy, Islamabad, Pakistan, 2Xi'an Jiaotong University, Department of Pharmacy, The First Affiliated Hospital, Xi'an, China, 3Xi'an Jiaotong University, Department of Pharmacy, The First Affiliated Hospital, Xi’an, China, 4Xi'an Jiaotong University, Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an, China
1Quaid-i-Azam University, Department of Pharmacy, Islamabad, Pakistan, 2Xi'an Jiaotong University, Department of Pharmacy, The First Affiliated Hospital, Xi'an, China, 3Xi'an Jiaotong University, Department of Pharmacy, The First Affiliated Hospital, Xi’an, China, 4Xi'an Jiaotong University, Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an, China
OBJECTIVES: Equitable access to essential medicines is a cornerstone of universal health coverage; however, substantial disparities in medicine availability, pricing, and affordability persist in many low- and middle-income countries, including Pakistan. To evaluate the availability, prices, and affordability of essential cardiovascular and antidiabetic medicines across public and private healthcare sectors using the WHO/Health Action International (WHO/HAI) methodology.
METHODS: A cross-sectional survey of 32 essential cardiovascular and antidiabetic medicines was conducted across six selected regions. Medicine availability was assessed as the percentage of facilities with medicines in stock on the day of data collection. Prices were analyzed using median price ratios (MPRs) relative to international reference prices. Affordability was estimated as the number of days’ wages required by the lowest-paid unskilled government worker to purchase a standard 30-day treatment. Sectoral and regional differences were examined using chi-square tests.
RESULTS: Overall availability of essential cardiovascular and antidiabetic medicines was suboptimal, particularly in public sector facilities. Originator brands (OBs) and lowest-priced generics (LPGs) were significantly more available in private pharmacies than in public facilities (χ²=180.6, p<0.001). Marked geographic disparities were observed, with rural areas demonstrating critically poor access (χ²=202.8, p<0.001), while Gujranwala showed comparatively higher availability. Although OBs, especially insulin analogues, were substantially more expensive than LPGs, generic medicines consistently demonstrated superior affordability across all therapeutic classes. Both public and private sectors exhibited inadequate availability of insulin and emergency medicines, failing to meet WHO availability targets.
CONCLUSIONS: Significant sectoral and regional inequities in the availability and affordability of essential medicines persist in Pakistan. Strengthening public-sector supply chains, promoting generic medicine utilization, and implementing effective pricing and reimbursement policies are urgently needed to improve access to life-saving therapies for cardiovascular diseases and diabetes.
METHODS: A cross-sectional survey of 32 essential cardiovascular and antidiabetic medicines was conducted across six selected regions. Medicine availability was assessed as the percentage of facilities with medicines in stock on the day of data collection. Prices were analyzed using median price ratios (MPRs) relative to international reference prices. Affordability was estimated as the number of days’ wages required by the lowest-paid unskilled government worker to purchase a standard 30-day treatment. Sectoral and regional differences were examined using chi-square tests.
RESULTS: Overall availability of essential cardiovascular and antidiabetic medicines was suboptimal, particularly in public sector facilities. Originator brands (OBs) and lowest-priced generics (LPGs) were significantly more available in private pharmacies than in public facilities (χ²=180.6, p<0.001). Marked geographic disparities were observed, with rural areas demonstrating critically poor access (χ²=202.8, p<0.001), while Gujranwala showed comparatively higher availability. Although OBs, especially insulin analogues, were substantially more expensive than LPGs, generic medicines consistently demonstrated superior affordability across all therapeutic classes. Both public and private sectors exhibited inadequate availability of insulin and emergency medicines, failing to meet WHO availability targets.
CONCLUSIONS: Significant sectoral and regional inequities in the availability and affordability of essential medicines persist in Pakistan. Strengthening public-sector supply chains, promoting generic medicine utilization, and implementing effective pricing and reimbursement policies are urgently needed to improve access to life-saving therapies for cardiovascular diseases and diabetes.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE213
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)