Pais P Therefore, we might have underestimated overall rates of statin use, and our results might not be generalizable to statin use in the public sector. endstream The study found that 1 in 10 Canadian adults was taking statins, but this fell far short of the 1 in 4 who would be recommended for treatment under the guidelines. , , Explaining the decrease in U.S. deaths from coronary disease, 1980–2000, Yusuf S Reddy KS Indian pharmacists, in turn, market brand-name drugs to consumers, who may have difficulty evaluating the quality of recommendations being made to them. Schech SD Combination products were categorized into mutually exclusive groups based on the following nonstatin agent or agents that they contained: angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB); antiplatelet agent (aspirin or clopidogrel); ACE inhibitor or ARB and an antiplatelet agent; metformin; vitamin; other cholesterol-lowering agent; and other cholesterol-lowering agent and vitamin. / , Cohort studies have found that statins are received by approximately half of the Indians who have acute coronary syndromes when they are discharged from a hospital 51 and only 20 percent of patients who have established CHD during a primary care visit. Their current statin use was then compared with their risk. Haynes RB, Interventions to enhance medication adherence in chronic medical conditions: a systematic review, Wald NJ Singal GL, Spurious and counterfeit drugs: a growing industry in the developing world. endobj , Bhargava A, Financial incentives and the prescription of newer vaccines by doctors in India, Medical regulator urges doctors to prescribe generic drugs, India’s capping of drug prices will leave drugs costing near the market price, Nagral S Boyle JP 15 … Exhibit 3 Statin Prescriptions Per 1,000 Population And 1,000 Patients With Coronary Heart Disease (CHD), February 2006–January 2010. Our analysis of national sales data demonstrates substantial differences in statin use and availability in India compared to the situation in Western countries. Jagadeesan M 57. Combination products may increase adherence by reducing regimen burden, 23 which is a key motivation behind efforts to introduce a polypill—a single, multicomponent pill—to reduce cardiovascular risk. Brookhart MA , Effects of a polypill (Polycap) on risk factors in middle-aged individuals without cardiovascular disease (TIPS): a phase II, double-blind, randomised trial, Xavier D Pollicino C Rosuvastatin use increased in 2009, but that statin still had less than 5 percent of the market share. La Grenade L Anand S, Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization, Gupta R Exhibit 3 Statin Prescriptions Per 1,000 Population And 1,000 Patients With Coronary Heart Disease (CHD), February 2006–January 2010 SOURCE Authors’ analysis of data from IMS Health’s Stockist Sales Audit database. , Critchley JA The database contains information about the number and cost of packages of medication sold to pharmacies; the generic and brand name of each product; its manufacturer, dosage, and number of tablets per package; and whether or not the medication is sold in combination with other active ingredients. During the period, monthly statin prescriptions increased from 45.8 to 84.1 per 1,000 patients with coronary heart disease—an increase of 0.80 prescriptions per month. , Bana A endstream endstream 6, 18 August 2016 | Health Policy and Planning, Vol. Stedman M , Baigent C Kasliwal A , 2017-07-10T19:52:38Z As many as 20-25% patients in observational studies have statin intolerance. Patel V , Based on this information, we used linear regression to estimate trends and disease prevalence for 2006, 2007, 2008, and 2009. Finucane MM No products that combined a statin, thiazide, ACE inhibitor or ARB, beta-blocker, and antiplatelet agent—all of the components of the polypill discussed below—were available in India during the study period. , , , Statins are usually used to lower blood cholesterol levels and reduce risk for illnesses related to atherosclerosis, with a varying degree of effect depending on underlying risk factors and history of cardiovascular disease. , STATIN’s survey programme begun in 1968 with the Labour Force Survey and has expanded over the years to include both routine and ad hoc surveys. endobj Sacks FM Pelizzari PM However, little is known about … Kearney PM Rutherford JD 24 No polypill was available in India during the study period, as noted above. Of note, however, the availability of generic statins does not necessary result in continu-ously declining statin prices. , 22 Surprisingly, in India combination products are less expensive than statins alone, which may create incentives for their adoption. Pai SA, Drug promotional practices in Mumbai: a qualitative study, Drug marketing in the Third World: beneath the cosmetic reforms, Lodha R 19,20. Roy S , endstream However, with prescription rates of approximately 8,000 per 100,000 patients with CHD in January 2010, only a minority of patients who would receive statin therapy in other countries appear to be receiving the therapy in India. 17, No. Using this measure makes it possible to make comparisons across medications with different relative potencies. Furthermore, prices paid by consumers are generally higher than those paid by stockists. Reddy KS In January 2010, 259 unique statin products produced by sixty-five manufacturers were available to Indian consumers ( Exhibit 1 ). As a result, monitoring the sale, prescribing, and marketing of combination products in India should be a priority for the government. 22 0 obj NOTES Market share is percentage of defined daily doses. For example, we did not have access to the prices that pharmacists charged patients, but we conservatively estimated that the price of statins in India was a few cents per pill, which is similar to what many US consumers pay for generic statins. endstream , He is now chief scientific officer for CVS Caremark, in Woonsocket, Rhode Island. Prabhakaran D Agrawal A Readmore Labour Force July 2020. Akdim F In addition, more than 80 percent of Indians have no health insurance and must pay out of pocket for all medications and health care services. Eikelboom J 3 0 obj , Joseph A. Hill, M.D., Ph.D. 21 Statin sales based on DDD increased at a faster rate than those based on prescriptions (there was a 106.8 percent increase in prescriptions and a 161.8 percent increase in DDD), which suggests a shift over time toward higher doses and more potent statins. %���� Cholesterol and Recurrent Events Trial investigators, Goyal R Karan AP, Why publicly-financed health insurance schemes are ineffective in providing financial risk protection. , , Thus, atorvastatin—which was sold in the United States only as a brand-name drug during our study period—had a lower price in India than simvastatin does. , x�S�*�*T0T0 B�����i������ yA$ India is of interest because of its burden of cardiovascular disease, the unique nature of its prescription drug market, and the growing globalization of drug sales.
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