Availability, Prices, and Affordability of Essential Cardiovascular Medicines in Tripoli, Libya: A Cross-Sectional Survey

Cardiovascular diseases (CVDs) remain the leading cause of death worldwide. In many low-income and middle-income countries, these fatalities are exacerbated by poor accessibility and affordability of essential cardiovascular medications. This study was aimed to investigate the availability, prices, and affordability of essential CVD medications, and to determine the key factors influencing these outcomes in Tripoli, Libya. The World Health Organization/Health Action International method was employed to survey a convenience sample of 200 community pharmacies for 17 essential CVD medications in September 2023. Data on availability, presence of an import sticker, and prices of the originator brand (OB) and lowest-priced generic (LPG) for each medication were collected. The main measured variables were the percentage availability, the proportion of medications with an import sticker, the median price ratio (MPR), the price variation among pharmacies, the ratio of OB to LPG prices, and the affordability. The affordability was expressed in terms of the number of days a lowest-paid government employee would need to work to pay for a 1-month supply of medication. Descriptive statistics using Excel and R summarized availability, prices, and affordability. The Mann–Whitney U test compared metrics between originator and generic medicines. Spearman's rank correlation (ρ) assessed variable relationships, and a mixed-effects linear regression model identified price determinants. The mean availability of OBs was significantly lower than that of LPGs (25.6 vs. 55.9%, p < 0.007). A total of 13% of OBs had an import sticker, whereas only 1% of LPGs did. Dispensing prices were higher than international reference prices for both OBs (MPR = 7.4) and LPGs (MPR = 3.7). Price variation across pharmacies exceeded a 4-fold difference for both OBs and LPGs. The OB/LPG price ratio was greater than 2. The cost of 1-month treatment courses exceeded 1-day wage on average for both OBs (2.9, 95% confidence interval [CI]: 1.7–4.1) and LPGs (1.5, 95% CI: 0.7–2.3). The availability level was negatively correlated with the days' wages (ρ = − 0.42, p < 0.04) and positively correlated with the number of manufacturing countries and competing manufacturers (ρ = 0.5, p < 0.01). Conversely, the required number of days' wages was positively correlated with the median unit price (ρ = 0.59, p < 0.01). Prices were significantly influenced by drug type (OB/LPG), drug class, and the region of manufacturer (Africa/ Asia). Essential CVD medications in Tripoli were found to have suboptimal availability and poor affordability. The price variation and the lack of importer information suggest systemic issues in the supply chain and distribution that require policy interventions.