Health system interventions for the cost containment of drugs used for cardiovascular diseases: a systematic review and exploration of how the results could be adapted to the Sri Lankan context

Abstract

Objectives

Cardiovascular disease (CVD) in low and middle-income countries (LMICs), accounts for over 80% of global CVD-related deaths. The high cost of drugs is a major concern in not of managing CVD. This study aimed to conduct a comprehensive review to identify interventions for cost containment of CVD drugs and use the intervention scalability assessment tool (ISAT) to examine the acceptability and application of relevant interventions in the Sri Lankan context, that can also be adaptable to other LMICs.

Methods

A systematic search across three databases (Medline, Web of Science and Embase) was completed to identify relevant health system interventions. The ISAT assessed the feasibility of adapting the identified interventions to Sri Lanka, using structured interviews with 25 Sri Lankan stakeholders representing five groups: health managers, cardiologists, pharmacists, nursing officers, and patients.

Results

The search yielded nine publications. Five were conducted on a national scale, while others were conducted at the regional levels. Seven were published in developed countries. The identified interventions were categorised into six intervention themes: Imposing a ceiling price or reference price; introduction of the polypill; introduction of volume price contract initiatives; prescribing generic and essential drugs; one intervention package including generics, essential medicine, 90-day drugs, and free delivery; and a second intervention package including discounts, rebates, cost-free medicine, and bundling. Assessment of six intervention themes revealed that methods of setting ceiling prices and controlling generic drug prescribing were the most popular, while other interventions were least popular.

Conclusions

The study provides a roadmap for future interventions based on successful scaling, emphasizing the importance of understanding contextual variables and encourages stakeholder participation in policy assessments and advocacy. The findings highlighted the potential for enhancing the access to affordable CVD drugs not only in Sri Lanka, but also adaptable to other LMICs. These outcomes can contribute to policy decisions, aimed at reducing the significant global burden of CVD.