ANALYSIS OF AFFORDABILITY OF THE FIRST LINE ANTIHYPERTENSIVE DRUGS FOR THE UKRAINIAN PATIENTS

Hpertension is one of the major medical and social problems in our country and around the world due to its significant prevalence and serious consequences, and this fact has determined the object and the aim of our study. The aim of the study was to determine affordability of the first line antihypertensive drugs recommended by the Unified Clinical Protocol of Medical Care to Patients with Hypertension (UCPMC) and presented at the pharmaceutical market of Ukraine in 20132014 for the Ukrainian patients. Two indicators were used to characterize the level of affordability of antihypertensive drugs: Ca.s and A. Ca.s determines the percentage of the average wage to be paid by the patient for the price of 1 package of a drug, and the greater value it has, the less affordable is the drug. The affordability ratio A shows the relationship between the growth of the living wage based on the index of growth of the drug price and the increase in the minimum wage. The study has revealed that the first line antihypertensive drugs (TNs) on the basis of 36 INNs and 35 fixed combinations were presented at the Ukrainian pharmaceutical market in 2013 and 2014. In 2014 the increase in the value of Ca.s for all INNs and all combinations was observed. It indicates the tendency towards decrease in affordability of drugs. However, by the absolute value most of Ca.s values are still in the range of highly affordable drugs, and it is provided by the presence of a great number of generic drugs at the market. The dynamics of A values has also confirmed the tendency towards decrease in affordability of antihypertensive drugs and their combinations. For example, 9 INNs and 5 combinations had A < 1 in 2013, and 32 INNs and 28 combinations – in 2014. This tendency of decrease in affordability of drugs necessitates introduction of socioeconomic measures to support the impoverished population of Ukraine; these measures may include reimbursement of expenditures on antihypertensive therapy at the expense of the state.

C ardiovascular disease ranks first among causes of death, disability and inability to work of the population. Hypertension (HTN) is the most common chronic di sease that leads to development of a variety of vascular and car diac complications [2].
In Ukraine, the prevalence of HTN among circulatory diseases is 46.8%, and almost half of the patients have cardiovascular di seases (CVD). Among the costs for the treatment of CVD the costs as sociated with the inpatient treat ment of patients (60%) prevail [4].
Hypertension is one of the major medical and social prob lems in our country and around the world due to its significant prevalence and serious consequences. According to the WHO experts in the future mortality from hyper tension will increase, firstly, due to aging of the population, and secondly, -to increasing preva lence of such risk factors as obe sity, physical inactivity, diabetes, smoking, psycho-emotional stress, etc., in the population of many countries [3].
Hypertension is a disease of the cardiovascular system that de velops due to the dysfunction of vasoregulative centers, followed by disturbances in the system of neurohumoral and renal mecha nisms, and is characterized by increased blood pressure, secondary functional and organic changes in target organs [5].
It is quite logical for each person to obtain the maximum therapeutic effect at minimum cost. But the high incidence rate, fre quency of complications, disability and administration of drugs throughout later life indicate significant economic costs for patients. Taking all this into account it is relevant today to conduct the pharmacoeconomic evaluation of the treatment of hypertension and substantiate expediency for selecting a drug to optimize costs [8].
The aim of the study is to de termine affordability of the first line antihypertensive drugs recommended by the Unified Clinical Protocol of Medical Care to Patients with Hypertension (UCPMC) in Ukraine in 20132014 for the Ukrainian patients.

Materials and Methods
Data on hypotensive drugs were taken from Morion research and retrieval system "Likarski zasoby" [4] for 2013-2014. Drugs for the analysis were selected on the ba sis of antihypertensive drugs included in the Unified Clinical Protocol of Medical Care to Patients with Hypertension for 2012 and recommended for the treatment of hypertension. They are presen ted in Table 1 [7].
To determine affordability of antihypertensive drugs, the coef-ficient of the solvency adequacy (Ca.s) and the affordability ratio (A) [3] were calculated by the for mula I and II, respectively: where: P -is the weighted average price of 1 package of a drug for a certain period (a year); W a.w. -is the average wage for a certain period (a year) [6].
Ca.s determines the percent age of the average wage to be paid by the patient for the price of 1 package of a drug. The lower the value of Ca.s is . , the more af fordable the antihypertensive drug is for the patient. Drugs with Ca.s of more than 15% are of low af fordability, from 5% to 15% -of average affordability and less than 5% -highly affordable.
where: Z min -is the minimum wage in the country; V k -is the living wage; I x -is the index of the minimum wage change (I x = Z n / Z n1 , Z n -is the wage within the year under study, Z n1 -is the minimum wage for the preceding year); I s -is the consolidated index of the drug price for the same period (I s = C n / C n1 , C n -is the average price within the year under stu dy, C n1 -is the average drug price for the preceding year).
The A ratio shows the relation ship between the indexed mini mum wage and the product between the living wage and the con-solidated index of the drug price. The affordability ratio is equal to one and is more satisfactory to provide availability of the drug to the public (A ≥ 1); it means that the minimum wage increases in proportion to the increase in the drug price, or even faster.

Results and Discussion
According to the analysis con-    According to the results of the calculation of affordability ratios (A) ( Table 2)