PDF(Pubmed)
Abstract：
The recent inclusion of polypills-fixed-dose combinations of antihypertensive medicines and a statin with or without aspirin-in the World Health Organization\'s Essential Medicines List (EML) reiterates the potential of this approach to improve global treatment coverage for cardiovascular diseases (CVDs). Although there exists extensive evidence on the effectiveness, safety and acceptability of polypills, there has been no research to date assessing the real-world availability and affordability of polypills globally.
We conducted a cross-sectional survey, based on the WHO/Health Action International methodology, in 13 countries around the world. In the surveyed countries, we first ascertained whether any polypill was authorised for marketing and/or included in EMLs and clinical guidelines. In each country, we collected retail and price data for polypills from at least one public-sector facility and three private pharmacies using convenience sampling. Polypills were considered unaffordable if the lowest-paid worker spent more than a day\'s wage to purchase a monthly supply.
Polypills were approved for marketing in four of the 13 surveyed countries: Spain, India, Mauritius and Argentina. None of these countries included polypills in national guidelines, formularies, or EMLs. In the four countries, no surveyed public pharmacies stocked polypills. In the private sector, we identified seven unique polypill combinations, marketed by eight different companies. Private sector availability was 100% in Argentina and Spain. Most combinations (n = 5) identified were in India. Combinations found in India and Spain were affordable in the local context. A lowest-paid government worker would spend between 0.2 (India) and 2.8 (Mauritius) days\' wages to pay the price for one month\'s supply of the polypills. Polypills were likely to be affordable if they were manufactured in the same country.
Low availability and affordability of polypills in the public sector suggest that implementation remains poor globally. Context-specific multi-disciplinary health system research is required to understand factors affecting polypill implementation and to design and evaluate appropriate implementation strategies.
We conducted a cross-sectional survey, based on the WHO/Health Action International methodology, in 13 countries around the world. In the surveyed countries, we first ascertained whether any polypill was authorised for marketing and/or included in EMLs and clinical guidelines. In each country, we collected retail and price data for polypills from at least one public-sector facility and three private pharmacies using convenience sampling. Polypills were considered unaffordable if the lowest-paid worker spent more than a day\'s wage to purchase a monthly supply.
Polypills were approved for marketing in four of the 13 surveyed countries: Spain, India, Mauritius and Argentina. None of these countries included polypills in national guidelines, formularies, or EMLs. In the four countries, no surveyed public pharmacies stocked polypills. In the private sector, we identified seven unique polypill combinations, marketed by eight different companies. Private sector availability was 100% in Argentina and Spain. Most combinations (n = 5) identified were in India. Combinations found in India and Spain were affordable in the local context. A lowest-paid government worker would spend between 0.2 (India) and 2.8 (Mauritius) days\' wages to pay the price for one month\'s supply of the polypills. Polypills were likely to be affordable if they were manufactured in the same country.
Low availability and affordability of polypills in the public sector suggest that implementation remains poor globally. Context-specific multi-disciplinary health system research is required to understand factors affecting polypill implementation and to design and evaluate appropriate implementation strategies.
摘要：
最近在世界卫生组织的基本药物清单（EML）中纳入了固定剂量的抗高血压药物和他汀类药物（含或不含阿司匹林）的药物组合，重申了这种方法在提高心血管疾病（CVD）全球治疗覆盖率方面的潜力。虽然有大量的证据证明其有效性，息肉的安全性和可接受性，迄今为止，还没有研究评估全球息肉病的实际可用性和可负担性。
■我们进行了横断面调查，根据世卫组织/卫生行动国际方法，在世界各地的13个国家。在被调查的国家,我们首先确定了任何息肉片是否被授权上市和/或是否被纳入EML和临床指南.在每个国家,我们使用便利抽样从至少一家公共部门机构和三家私人药房收集了polypills的零售和价格数据.如果收入最低的工人花了一天以上的工资来购买每月的供应，那么Polypills被认为是负担不起的。
■在13个接受调查的国家中，有4个国家/地区批准了Polypills上市：西班牙，印度,毛里求斯和阿根廷。这些国家都没有将polypills纳入国家指南，处方集，或EML。在这四个国家，没有接受调查的公共药房储存息肉。在私营部门，我们确定了七个独特的息肉组合，由八家不同的公司销售。阿根廷和西班牙的私营部门可用性为100%。确定的大多数组合(n=5)在印度。在印度和西班牙发现的组合在当地是负担得起的。收入最低的政府工作人员将花费0.2天（印度）至2.8天（毛里求斯）的工资来支付一个月供应的价格。如果在同一国家生产，则息肉可能负担得起。
■公共部门的polyills的可获得性和可负担性很低，这表明全球范围内的执行情况仍然很差。需要针对特定环境的多学科卫生系统研究，以了解影响多病菌实施的因素，并设计和评估适当的实施策略。
■我们进行了横断面调查，根据世卫组织/卫生行动国际方法，在世界各地的13个国家。在被调查的国家,我们首先确定了任何息肉片是否被授权上市和/或是否被纳入EML和临床指南.在每个国家,我们使用便利抽样从至少一家公共部门机构和三家私人药房收集了polypills的零售和价格数据.如果收入最低的工人花了一天以上的工资来购买每月的供应，那么Polypills被认为是负担不起的。
■在13个接受调查的国家中，有4个国家/地区批准了Polypills上市：西班牙，印度,毛里求斯和阿根廷。这些国家都没有将polypills纳入国家指南，处方集，或EML。在这四个国家，没有接受调查的公共药房储存息肉。在私营部门，我们确定了七个独特的息肉组合，由八家不同的公司销售。阿根廷和西班牙的私营部门可用性为100%。确定的大多数组合(n=5)在印度。在印度和西班牙发现的组合在当地是负担得起的。收入最低的政府工作人员将花费0.2天（印度）至2.8天（毛里求斯）的工资来支付一个月供应的价格。如果在同一国家生产，则息肉可能负担得起。
■公共部门的polyills的可获得性和可负担性很低，这表明全球范围内的执行情况仍然很差。需要针对特定环境的多学科卫生系统研究，以了解影响多病菌实施的因素，并设计和评估适当的实施策略。
