Pharmacological treatment for pulmonary arterial hypertension: availability and access in Latin America and The Caribbean

Abstract

Introduction The management of Pulmonary Arterial Hypertension (PAH) includes pharmacological and surgical strategies to control symptoms and increase survival. Current management guidelines provide recommendations about these strategies; however, their availability may be limited in different regions of the world.

Objective To evaluate the current availability and access to the pharmacological strategies for the management of PAH in Latin America and the Caribbean (LA&C).

Methodology The Council on Heart Failure and Pulmonary Hypertension (CIFACAH) of the Inter-American Society of Cardiology (SIAC) conducted a survey to evaluate the availability and access (cost paid by patient) of pharmacological, interventional and surgical options for PAH in February 2023. Delegates from 21 LA&C countries that are part of the SIAC received and completed the survey.

Results Regarding pharmacological treatment for PAH, 100% of the countries have access to at least one nitric oxide pathway medication (sildenafil), 81% of the countries have access to at least one endothelin pathway medication and 81% of the countries have access to at least one prostanoid pathway medication (Table #1).The survey classified access to pharmacological therapies as the percentage of the cost / value of medication that must be paid by the patient, as follows: 0%: No additional payment; <50%: pay for lest that 50% of the cost; 50-99%: Pay for most of the medication; 100%: Pay for all.Access to at least one medication at 0% cost (no additional payment) for nitric oxide pathway therapy, endothelin pathway therapy and prostacyclin pathway therapy is available in 67%, 67% and 76% of the countries, respectively. By the other side, access to at least one medication paying full cost (100%) for nitric oxide pathway therapy, endothelin pathway therapy and prostacyclin pathway therapy is available in 76%, 67% and 59% of the countries, respectively.

Conclusion The availability of pharmacological treatment for PAH is high and varies between pharmacological groups and different countries in LA&C. However, availability is different from accessibility, as the latter depends on many factors, including cost. Access to these medications at no cost or at full cost is available in almost two-thirds of LA&C countries, although most countries have health care systems that cover a percentage of the medication cost.