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Article: Essential medicines for cardiovascular diseases in India: Rapid appraisal of policies and processes at the subnational level.

Garg, Ankur / Murphy, Adrianna / Krishna, Ashish / Sahoo, Swagata Kumar / Huffman, Mark D / Kishore, Sandeep P / Shivashankar, Roopa

The National medical journal of India

2023 Volume 35, Issue 6, Page(s) 357–363

Abstract: Background The burden of cardiovascular diseases (CVDs) and response to health systems vary widely at the subnational level in India. Our study aimed to assess the variation in state-level access to medicines for CVDs by comparing the essential medicines ...

Abstract	Background The burden of cardiovascular diseases (CVDs) and response to health systems vary widely at the subnational level in India. Our study aimed to assess the variation in state-level access to medicines for CVDs by comparing the essential medicines lists (EMLs) at the national and subnational levels in India and by rapid appraisal of the existing policies and processes of drug procurement. Methods We assessed the inclusion of six classes of medicines for CVDs in the recent and publicly available national and subnational EMLs from July to September 2018 in the states of Telangana and Madhya Pradesh. We examined the drug procurement and distribution policies and processes using documentary review and five key informant interviews between March and June 2018. Results The WHO's EML, India's national EML, and 21 of 28 publicly available (75%) Indian state and Union Territory EMLs included all six classes of essential medicines for CVDs. However, some medicines were not included in the policy packages of essential medicines meant for primary health centres. Both the states used centralized tendering and decentralized distribution as part of the public sector drug procurement process. The requirement was based on the previous year's consumption. The approximate time between procurement planning and distribution was 7-8 months in both the states. Conclusion Substantial variation exists in the selection of drugs for CVDs in EMLs at the subnational level in India. Improving forecasting techniques for requirement of medicines and reducing time lags between forecasting and distribution to health facilities may allow for better access to essential medicines.
MeSH term(s)	Humans ; Cardiovascular Diseases/drug therapy ; Cardiovascular Diseases/epidemiology ; Policy ; Drugs, Essential ; India/epidemiology ; Public Sector
Chemical Substances	Drugs, Essential
Language	English
Publishing date	2023-05-12
Publishing country	India
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	645116-0
ISSN	0970-258X
ISSN	0970-258X
DOI	10.25259/NMJI_35_6_357
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 2493: Show issues

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Article ; Online: Financial implications of protocol-based hypertension treatment: an insight into medication costs in public and private health sectors in India.

Sahoo, Swagata Kumar / Pathni, Anupam Khungar / Krishna, Ashish / Sharma, Bhawna / Cazabon, Danielle / Moran, Andrew E / Hering, Dagmara

Journal of human hypertension

2022 Volume 37, Issue 9, Page(s) 828–834

Abstract: Hypertension is a major public health challenge in low- and middle-income countries (LMICs) and calls for large-scale effective hypertension control programs. Adoption of drug and dose-specific treatment protocols recommended by the World Health ... ...

Abstract	Hypertension is a major public health challenge in low- and middle-income countries (LMICs) and calls for large-scale effective hypertension control programs. Adoption of drug and dose-specific treatment protocols recommended by the World Health Organization-HEARTS Initiative is key for hypertension control programs in LMICs. We estimated the annual medication cost per patient using three such protocols (protocol-1 and protocol-2 with Amlodipine, Telmisartan, using add-on doses and different drug orders, adding Chlorthalidone; protocol-3 with a single-pill combination (SPC) of Amlodipine/Telmisartan with dose up-titration, and addition of Chlorthalidone, if required) in India. The medication cost was simulated with different hypertension control assumptions for each protocol and calculated based on prices in the public and private sectors in India. The estimated annual medication cost per patient for protocol-1 and protocol-2 was $33.88-58.44 and $51.57-68.83 for protocol-3 in the private sector. The medication cost was lower in the generic stores ($5.78-9.57 for protocol-1 and protocol-2, and $7.35-9.89 for protocol-3). The medication cost for patients was the lowest ($2.05-3.89 for protocol-1 and protocol-2, and $2.94-3.98 for protocol-3) in the public sector. At less than $4 per patient per annum, scaling up a hypertension control program with specific treatment protocols is a potentially cost-effective public health intervention. Expanding low-cost generic retail networks would extend affordability in the private sector. The cost of treatment with SPC is comparable with non-SPC protocols and can be adopted in a public health program considering the advantage of simplified logistics, reduced pill burden, improved treatment adherence, and blood pressure control.
MeSH term(s)	Humans ; Telmisartan/therapeutic use ; Chlorthalidone/therapeutic use ; Private Sector ; Hypertension/drug therapy ; Amlodipine/therapeutic use ; India
Chemical Substances	Telmisartan (U5SYW473RQ) ; Chlorthalidone (Q0MQD1073Q) ; Amlodipine (1J444QC288)
Language	English
Publishing date	2022-10-21
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639472-3
ISSN	1476-5527 ; 0950-9240
ISSN (online)	1476-5527
ISSN	0950-9240
DOI	10.1038/s41371-022-00766-x
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 2380: Show issues

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Article ; Online: Research Letter: Unmet Need for Hypertension Treatment in India: Evidence from Hypertension Drugs Market Data.

Pathni, Anupam Khungar / Sahoo, Swagata Kumar / Moran, Andrew E / Cohn, Jennifer / Bhatia, Sanchit / Maheshwari, Nilesh / Sharma, Bhawna

Global heart

2021 Volume 16, Issue 1, Page(s) 26

MeSH term(s)	Cardiovascular Agents ; Humans ; Hypertension/drug therapy ; Hypertension/epidemiology ; India/epidemiology ; Pharmaceutical Preparations
Chemical Substances	Cardiovascular Agents ; Pharmaceutical Preparations
Language	English
Publishing date	2021-04-23
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2629633-0
ISSN	2211-8179 ; 2211-8160
ISSN (online)	2211-8179
ISSN	2211-8160
DOI	10.5334/gh.973
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Research Letter: Antihypertensive Drugs Market in India: An Insight on Size, Trends, and Prescribing Preferences in the Private Health Sector, 2016-2018.

Sahoo, Swagata Kumar / Pathni, Anupam Khungar / Krishna, Ashish / Moran, Andrew E / Cohn, Jennifer / Bhatia, Sanchit / Maheshwari, Nilesh / Sharma, Bhawna

Global heart

2021 Volume 16, Issue 1, Page(s) 51

Abstract: Background: India has a high burden of hypertension. While the private sector provides 70% of out-patient care in the country, a significant proportion of patients seeking care from the public sector buy drugs from private markets. This study aimed to ... ...

Abstract	Background: India has a high burden of hypertension. While the private sector provides 70% of out-patient care in the country, a significant proportion of patients seeking care from the public sector buy drugs from private markets. This study aimed to describe India's private sector antihypertensive drugs market at the national and state levels over 2016-2018. Methods: Antihypertensive drugs sales in India from 2016-2018 were analysed using a large nationally representative dataset for the private pharmaceuticals market. In addition, data for five states (Punjab, Madhya Pradesh, Kerala, Telangana, and Maharashtra) that were the foci of a large hypertension control program were studied. Results: The Indian hypertension drug market grew at a rate of 6.9% from 2016 to 2018 with a total of 21,066 million pills sales in 2018. Single-pill combinations (SPCs) contributed to 39.1% of total sale volumes. The market comprised of 182 different antihypertensive drugs including 134 SPCs. Total volume of sales covered a maximum of 26% of treatment need for the estimated population with hypertension. Two-drug SPCs had the highest market share (36%), followed by calcium channel blockers (18%), beta-blockers (16%) and angiotensin receptor blockers (14%). Among SPCs, amlodipine+atenolol had highest sales (9.8%). Twenty-five drugs, a mix of single drugs and SPCs, accounted for 80% of total sales. There were large state-to-state variations in sales per capita, preferred therapeutic classes and drugs. Conclusions: Despite the large antihypertensive drugs market, there exists a high unmet need for treatment in India. Inter-state differences in product sales indicate variable treatment practices, underscoring the need for private sector engagement to improve hypertension care practices aligned with national and international guidelines. SPCs contributed to a large share of the private market and inclusion of select antihypertensive SPCs in the national list of essential medications should be considered for the public health system.
MeSH term(s)	Antihypertensive Agents/therapeutic use ; Humans ; Hypertension/drug therapy ; Hypertension/epidemiology ; India/epidemiology ; Private Sector ; Public Sector
Chemical Substances	Antihypertensive Agents
Language	English
Publishing date	2021-08-02
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2629633-0
ISSN	2211-8179 ; 2211-8160
ISSN (online)	2211-8179
ISSN	2211-8160
DOI	10.5334/gh.999
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: India Hypertension Control Initiative: Blood Pressure Control Using Drug and Dose-Specific Standard Treatment Protocol at Scale in Punjab and Maharashtra, India, 2022.

Kaur, Prabhdeep / Sakthivel, Manikandanesan / Venkatasamy, Vettrichelvan / Jogewar, Padmaja / Gill, Sandeep S / Kunwar, Abhishek / Sharma, Meenakshi / Pathni, Anupam Khungar / Durgad, Kiran / Sahoo, Swagata Kumar / Wankhede, Amol / Kumar, Navneet / Bharadwaj, Vishwajit / Das, Bidisha / Chavan, Tejpalsinh / Khedkar, Suhas / Sarode, Lalit / Bangar, Sampada D / Krishna, Ashish /

Shivashankar, Roopa / Ganeshkumar, Parasuraman / Pragya, Pragati / Bhargava, Balram

Global heart

2024 Volume 19, Issue 1, Page(s) 30

Abstract: Background: Hypertension treatment coverage is low in India. A stepwise simple treatment protocol is one of the strategies to improve hypertension treatment in primary care. We estimated the effectiveness of various protocol steps to achieve blood ... ...

Abstract	Background: Hypertension treatment coverage is low in India. A stepwise simple treatment protocol is one of the strategies to improve hypertension treatment in primary care. We estimated the effectiveness of various protocol steps to achieve blood pressure (BP) control in public sector health facilities in Punjab and Maharashtra, India, where the India Hypertension Control Initiative (IHCI) was implemented. Methods: We analyzed the records of people enrolled for hypertension treatment and follow-up under IHCI between January 2018 and December 2021 in public sector primary and secondary care facilities across 23 districts from two states. Each state followed a different treatment protocol. We calculated the proportion with controlled BP at each step of the protocol. We also estimated the mean decline in BP pre- and post-treatment. Results: Of 281,209 patients initiated on amlodipine 5 mg, 159,292 continued on protocol drugs and came for a follow-up visit during the first quarter of 2022. Of 33,450 individuals who came for the follow-up in Punjab and 125,842 in Maharashtra, 70% and 76% had controlled BP, respectively, at the first step with amlodipine 5 mg. In Punjab, at the second step with amlodipine 10 mg, the cumulative BP control increased to 75%. A similar 5% (76%-81%) increase was seen in the second step after adding telmisartan 40 mg in Maharashtra. Overall, the mean (SD) systolic blood pressure (SBP) decreased by 16 mmHg from 148 (15) mmHg at the baseline in Punjab. In Maharashtra, the decline in the mean (SD) SBP was about 15 mmHg from the 144 (18) mmHg baseline. Conclusion: Simple drug- and dose-specific protocols helped achieve a high control rate among patients retained in care under program conditions. We recommend treatment protocols starting with a single low-cost drug and escalating with the same or another antihypertensive drug depending on the cost and availability.
MeSH term(s)	Humans ; Blood Pressure ; India/epidemiology ; Hypertension/drug therapy ; Hypertension/epidemiology ; Antihypertensive Agents/therapeutic use ; Antihypertensive Agents/pharmacology ; Amlodipine ; Clinical Protocols ; Treatment Outcome
Chemical Substances	Antihypertensive Agents ; Amlodipine (1J444QC288)
Language	English
Publishing date	2024-03-19
Publishing country	England
Document type	Journal Article
ZDB-ID	2629633-0
ISSN	2211-8179 ; 2211-8160
ISSN (online)	2211-8179
ISSN	2211-8160
DOI	10.5334/gh.1305
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Prices of combination medicines and single-molecule antihypertensive medicines in India's private health care sector.

Negi, Sagri / Neupane, Dinesh / Sahoo, Swagata Kumar / Mahajan, Tanushree / Swaroop, Kishan / Moran, Andrew E / Sharma, Bhawna / Pathni, Anupam Khungar

Journal of clinical hypertension (Greenwich, Conn.)

2020 Volume 23, Issue 4, Page(s) 738–743

Abstract: More than half of patients with hypertension require two or more medicines to control blood pressure. Combinations of anti-hypertensive medicines are available as Single Pill Combinations (SPCs) or Single Agent Pills (SAPs). SPCs of two or more anti- ... ...

Abstract	More than half of patients with hypertension require two or more medicines to control blood pressure. Combinations of anti-hypertensive medicines are available as Single Pill Combinations (SPCs) or Single Agent Pills (SAPs). SPCs of two or more anti-hypertensive medicines facilitate simpler dosing schedules, decrease pill burden, increase adherence to medicine, and simplify procurement and distribution. Despite this, equivalent combinations of separate pills (SAPs) are often prescribed instead of SPCs under the assumption that SAPs are priced lower. This study compared prices of anti-hypertensive SPCs and equivalent SAPs in the private health care sector of India. High sales volume anti-hypertensive SPCs and SAPs were selected from 2018 private sector pharmaceutical sales data. SPCs and SAPs price information was collected from online pharmacy websites between November 2019 and January 2020. Anti-hypertensive SPCs represent approximately 39.1% of India's private sector anti-hypertensive drug market. Multiple manufacturers produce the same top-selling SPCs, suggesting a viable and competitive market. A comparison of SPCs and SAPs across different manufacturers showed that the lowest prices of both SPCs and the sum of component SAPs were nearly identical across different manufacturers. An analysis of dual-drug SPCs and SAPs by the same manufacturer showed that most manufacturers (five of six) had priced their SPCs higher than SAPs. These observations suggest that the price of SPCs could be lowered to match the combined price of the component SAPs, and manufacturing costs and market forces do not present a barrier to the implementation of anti-hypertensive SPCs.
MeSH term(s)	Antihypertensive Agents ; Drugs, Essential ; Health Care Sector ; Health Services Accessibility ; Humans ; Hypertension/drug therapy ; India ; Private Sector ; Public Sector
Chemical Substances	Antihypertensive Agents ; Drugs, Essential
Language	English
Publishing date	2020-12-24
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2077222-1
ISSN	1751-7176 ; 1524-6175
ISSN (online)	1751-7176
ISSN	1524-6175
DOI	10.1111/jch.14143
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Zs.A 5723: Show issues

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Article ; Online: Building the health-economic case for scaling up the WHO-HEARTS hypertension control package in low- and middle-income countries.

Revista panamericana de salud publica = Pan American journal of public health

2022 Volume 46, Page(s) e140

Abstract: Generally, hypertension control programs are cost-effective, including in low- and middle-income countries, but country governments and civil society are not likely to support hypertension control programs unless value is demonstrated in terms of public ... ...

Abstract	Generally, hypertension control programs are cost-effective, including in low- and middle-income countries, but country governments and civil society are not likely to support hypertension control programs unless value is demonstrated in terms of public health benefits, budget impact, and value-for-investment for the individual country context. The World Health Organization (WHO) and the Pan American Health Organization (PAHO) established a standard, simplified Global HEARTS approach to hypertension control, including preferred antihypertensive medicines and blood pressure measurement devices. The objective of this study is to report on health economic studies of HEARTS hypertension control package cost (especially medication costs), cost-effectiveness, and budget impact and describe mathematical models designed to translate hypertension control program data into the optimal approach to hypertension care service delivery and financing, especially in low- and middle-income countries. Early results suggest that HEARTS hypertension control interventions are either cost-saving or cost-effective, that the HEARTS package is affordable at between US$ 18-44 per person treated per year, and that antihypertensive medicines could be priced low enough to reach a global standard of an average <US$ 5 per patient per year in the public sector. This health economic evidence will make a compelling case for government ownership and financial support for national scale hypertension control programs.<br />
Language	English
Publishing date	2022-09-02
Publishing country	United States
Document type	Case Reports
ZDB-ID	1376934-0
ISSN	1680-5348 ; 1020-4989
ISSN (online)	1680-5348
ISSN	1020-4989
DOI	10.26633/RPSP.2022.140
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Article: Essential medicines for cardiovascular diseases in India: Rapid appraisal of policies and processes at the subnational level.

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Article ; Online: Financial implications of protocol-based hypertension treatment: an insight into medication costs in public and private health sectors in India.

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Article ; Online: Research Letter: Unmet Need for Hypertension Treatment in India: Evidence from Hypertension Drugs Market Data.

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Article ; Online: Research Letter: Antihypertensive Drugs Market in India: An Insight on Size, Trends, and Prescribing Preferences in the Private Health Sector, 2016-2018.

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Article ; Online: India Hypertension Control Initiative: Blood Pressure Control Using Drug and Dose-Specific Standard Treatment Protocol at Scale in Punjab and Maharashtra, India, 2022.

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Article ; Online: Prices of combination medicines and single-molecule antihypertensive medicines in India's private health care sector.

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Article ; Online: Building the health-economic case for scaling up the WHO-HEARTS hypertension control package in low- and middle-income countries.

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