印度喀拉拉邦戒烟药物的可及性、销售量及可负担性
Availability, Sales, and Affordability of Tobacco Cessation Medicines in Kerala, India.
作者信息
Sarma Smitha, Harikrishnan Sivadasanpillai, Baldridge Abigail S, Devarajan Raji, Mehta Aashna, Selvaraj Sakhtivel, Ali Mohammed K, Mohanan Padinhare P, Prabhakaran Dorairaj, Huffman Mark D
机构信息
From the Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (S. Sarma, A.S.B., M.D.H.); Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India (S.H.); Public Health Foundation of India and Centre for Chronic Disease Control, Gurgaon, Haryana, India (R.D., D.P.); Public Health Foundation of India, Gurgaon, Haryana, India (A.M.); Public Health Foundation of India, Delhi, India (S. Selvaraj); Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); and Department of Cardiology, Westfort Hi-Tech Hospital Ltd, Thrissur, Kerala, India (P.P.M.).
出版信息
Circ Cardiovasc Qual Outcomes. 2017 Nov;10(11). doi: 10.1161/CIRCOUTCOMES.117.004108.
BACKGROUND
India is the world's second largest consumer of tobacco, but tobacco cessation remains uncommon due, at least in part, to underutilization of cessation pharmacotherapy. We evaluated the availability, sales, and affordability of nicotine replacement therapy, bupropion, and varenicline in the South Indian state of Kerala to understand potential reasons for underutilization.
METHODS AND RESULTS
From November 2016 to April 2017, we collected data on availability, inventory, and pricing of cessation medication through a cross-sectional survey of 199 public, semiprivate (Karunya), and private pharmacies across 5 districts in Kerala using World Health Organization/Health Action International methodology. Revenue and sales data were obtained from the latest Pharmatrac medication database. We assessed affordability using individual- and household-level income and expenditure data collected from November 2014 to November 2016 through the Acute Coronary Syndrome Quality Improvement in Kerala randomized trial. Cessation medications were not available in public hospitals (0%, n=58) nor in public specialty centers (0%, n=10) including those designated to provide cessation services. At least 1 cessation medicine was available at 63% of private pharmacies (n=109) and 27% of Karunya (semiprivate) pharmacies (n=22). Among the 75 pharmacies that stocked cessation medications, 96% had nicotine replacement therapy, 28% had bupropion, and 1% had varenicline. No outlets had sufficient inventory for a patient to purchase a 12-week treatment regimen. There were an estimated 253 270 treatment regimens sold throughout India and 14 092 in Kerala in 2013 to 2014. Treatment regimens cost 1.9 to 13.0× the median amount spent on smoked tobacco and between 8% and 52% of nonsubsistence income.
CONCLUSIONS
Tobacco cessation medications are unavailable in the Kerala public sector and have limited availability in the private and semiprivate sectors. When available, medications are unaffordable for most patients. Addition of tobacco cessation medication onto national and state essential medicines lists may help increase access.
CLINICAL TRIAL REGISTRATION
URL: https://www.clinicaltrials.gov. Unique identifier: NCT02256657.
背景
印度是世界第二大烟草消费国，但戒烟仍不常见，至少部分原因是戒烟药物治疗未得到充分利用。我们评估了印度南部喀拉拉邦尼古丁替代疗法、安非他酮和伐尼克兰的可获得性、销售量和可负担性，以了解未得到充分利用的潜在原因。
方法与结果
2016年11月至2017年4月，我们采用世界卫生组织/国际卫生行动组织的方法，对喀拉拉邦5个地区的199家公立、半私立（卡鲁尼亚）和私立药店进行横断面调查，收集戒烟药物的可获得性、库存和价格数据。收入和销售数据来自最新的Pharmatrac药物数据库。我们使用2014年11月至2016年11月通过喀拉拉邦急性冠状动脉综合征质量改善随机试验收集的个人和家庭层面的收入与支出数据评估可负担性。公立医院（0%，n = 58）和包括指定提供戒烟服务的公立专科中心（0%，n = 10）均没有戒烟药物。63%的私立药店（n = 109）和27%的卡鲁尼亚（半私立）药店（n = 22）至少有1种戒烟药物。在75家储备戒烟药物的药店中，96%有尼古丁替代疗法，28%有安非他酮，1%有伐尼克兰。没有药店有足够库存供患者购买12周的治疗方案。2013年至2014年，印度全国估计售出253270个治疗方案，喀拉拉邦售出14092个。治疗方案的费用是吸烟支出中位数的1.9至13.0倍，占非生活必需收入的8%至52%。
结论
喀拉拉邦公共部门没有戒烟药物，在私立和半私立部门的可获得性有限。即使有药物，大多数患者也负担不起。将戒烟药物列入国家和邦的基本药物清单可能有助于增加可及性。
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