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Thomas A. Gaziano Reducing The Growing Burden Of Cardiovascular Disease In The Developing World Health Affairs, January/February 2007; 26(1): 13-24. [Abstract] [Full Text] [Figures Only] [PDF] [Reprints & Permissions]

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Electronic letters published:

Accessibility Of Statins Can Help Curb Cardiovascular Disease In The Developing World

Sandeep P. Kishore   ( 13 January 2007 )

DALYs And QALYs In Developing Countries

Victor Zarate   ( 30 January 2007 )

Accessibility Of Statins Can Help Curb Cardiovascular Disease In The Developing World 13 January 2007
Sandeep P. Kishore, Weill Cornell/ Rockefeller/ Sloan-Kettering Tri-Institutional MD-PhD Student Universities Allied for Essential Medicines (UAEM) Send letter to journal: Re: Accessibility Of Statins Can Help Curb Cardiovascular Disease In The Developing World sunny.kishore{at}gmail.com Sandeep P. Kishore	Gaziano's conclusion that cardiovascular disease (CVD) is the leading cause of death in the developing world raises pertinent issues for both the treatment and need for clear medical solutions for this growing epidemic. Enhanced, sustainable efforts to manage (and prevent) CVD are required, particularly in the developing world, where proven, blockbuster CVD medicines (e.g. statins) are underutilized. The perception has long been that drugs like statins are simply too expensive or not cost-effective in the developing world. However, as more and more statins become generic (e.g. simvastatin, Zocor), it is fast becoming clear that this is no longer the case. Indeed, data from several groups, including the World Health Organization (WHO), indicate that generic statins are cost-effective globally. In turn, our group and an international collaborator prepared and submitted an application to include the first generic statin for the secondary prevention of heart disease on the WHO Essential Medicines List or EML. If included, the medicines will be strongly recommended to national pharmacopeias, will qualify for drug donation by UN and WHO groups, and (in some cases) may receive striking price breaks. Increasing the accessibility of a statin via the WHO EML can help curb CVD in the developing world, but it is a step that must be taken in parallel with other pro-access schemes. In a word, the march to enhance the access of medicines to treat CVD must now soon match the great strides made for diseases such as HIV/AIDS.
DALYs And QALYs In Developing Countries 30 January 2007
Victor Zarate, Resident Pontificia Universidad Catolica de Chile Send letter to journal: Re: DALYs And QALYs In Developing Countries vzarate{at}med.puc.cl Victor Zarate	Thomas Gaziano has highlighted the growing importance that cardiovascular disease has in developing countries. He suggests that in order to make cost-effective decisions, alternative therapies should be compared in terms of cost-effectiveness ratios. It is on this issue where decisionmakers should show caution, as not only costs but also effectiveness can largely vary from country to country. The main factors that act as a barrier for generalizability of cost-effectiveness ratios are diversity in clinical practice patterns, limited availability of health care resources, and relative differences in price. Once transferability concerns are solved, decisionmakers still face two methodological dilemmas: which health outcome measurement should be preferred as the unit of effectiveness, and how much society is willing to pay for a particular health gain. DALYs [disability-adjusted life-years] and QALYs [quality-adjusted life-years] are two summary measures of effectiveness that are equally valid for application in economic appraisals. Nonetheless, DALYs seem more suitable to the developing world, since almost 90% of the global burden of disease is accounted for by developing regions. Although a recommended value for a DALY has been suggested, a fair value for a QALY is unknown in many societies. Empirical results have shown that implicit thresholds exist in some countries, like the well-known £30,000/QALY in the U.K. and the US$50,000/QALY in the USA. From applying the DALY formula (3xGNIpc) to the aforementioned countries and comparing the results with their QALY thresholds, it is possible to assume that the value of a QALY might be one or two times lower than the value of a DALY. Using the same relationship, a developing country like Chile, which had in 2005 a GNIpc [per capita gross national income] of US$5,870 should have a QALY threshold lower than 2 times its GNIpc (US$11,740). A similar procedure could be applied to other developing countries while no information on QALY values is available.