The organization and delivery of vaccination services in the European Union

Background

The design and operation of health systems can influence vaccine uptake, including through the way that vaccination programmes are governed, financed and delivered. This study examined the organization and delivery of vaccination programmes in the 28 EU member states and key barriers and facilitators to improved vaccination coverage.

Methods

We undertook an umbrella review of systematic reviews on health system related factors influencing vaccine uptake and commissioned country fiches that describe the organization and delivery of vaccination programmes in each of the EU member states, followed by a comparative analysis. The focus was on measles vaccination for children and seasonal influenza vaccination for adults.

Results

In all countries covered, there is a dedicated agency in charge of developing and overseeing implementation of national vaccination plans and programmes. In 9 EU member states (Bulgaria, Croatia, Czech Republic, France, Hungary, Italy, Poland, Slovakia and Slovenia), vaccinations against measles are mandatory for children, while in the remaining 19 countries they are voluntary, but recommended by the relevant authorities. However, the distinction between voluntary and mandatory immunization is not always clear-cut. In contrast, vaccinations for adults against influenza are voluntary in almost all EU member states, with the exception of Slovakia. Vaccinations are provided in most countries through primary care physicians or nurses.

Conclusions

There are many actions that health systems can take to improve vaccination coverage. These include a mix of incentives and sanctions, targeted measures and outreach services for vulnerable population groups, and an expansion of public financing for vaccinations against influenza, as well as the removal of administrative barriers.

CAN HEARING AIDS DELAY THE ONSET OF ALZHEIMER’S AND OTHER AGE-RELATED CONDITIONS AMONG ADULTS WITH HEARING LOSS?

In this study, we examined the association between hearing aids (HAs) and the onset of Alzheimer’s disease or dementia; depression or anxiety; drug or alcohol disorders; and falls among adults aged 50 and older with hearing loss (HL). We performed a retrospective study of 176,716 adults (50+) with HL diagnoses using a national, insurance claims data (2008-2016). We used Kaplan Meier curves to examine disease-free survival and Cox regression models to examine the risk-adjusted association between HAs and time to diagnosis of 4 age-related/HL-associated conditions within 3 years of HL diagnosis. Large gender and racial/ethnic differences exist in HAs use. Approximately 11.3% of women vs. 14.5% of men used HAs (95% CI Difference: -0.04, -0.03). About 14.1% of Whites (95% CI: 0.14, 0.14) vs. 9.5% of Blacks (95% CI: 0.09, 0.10) and 7.8% of Hispanics (95% CI: 0.07, 0.08) used HAs. The risk-adjusted hazard ratios of being diagnosed with Alzheimer’s disease or dementia, depression or anxiety, drug/alcohol disorders, and injurious falls within 3 years after HL diagnosis, for those who used HA vs. those who did not, were lower by 0.82 (95% CI: 0.76-0.88), 0.92 (95% CI: 0.89-0.95), 0.91 (95% CI:0.80-1.04), and 0.86 (95% CI: 0.81-0.92), respectively. Use of HAs is associated with delayed onset of Alzheimer’s, dementia, depression, anxiety, and injurious falls among adults 50 years of age and older with HL. This is important because HL are increasingly common among older adults and early HL diagnosis and use of HAs may prevent or delay physical and mental decline.

No UHC without medicines: out-of-pocket payments for non-communicable diseases in 18 countries

Background

In 2014 the United Nations agreed on a goal to reduce premature mortality from NCDs by improving financial risk protection. We are far from achieving this: households with NCDs are at an increased risk of catastrophic health spending and impoverishment, particularly in lower middle- and low-income countries. There is a need to better understand the drivers of health spending among households with NCDs, to inform interventions aimed at achieving universal health coverage.

Methods

Using data from the Prospective Urban and Rural Epidemiology Study, we analyse out-of-pocket expenditure (OOP) among households with NCDs (cancer, cardiovascular disease, hypertension, diabetes, respiratory disease or kidney disease) in 18 countries: Canada, Sweden, Brazil, Chile, Malaysia, Poland, South Africa, Turkey, China, the Philippines, Colombia, Iran, the Occupied Palestinian Territory (OPT), Bangladesh, India, Pakistan, Zimbabwe and Tanzania.

Results

The leading driver of OOP on health care in almost all countries included is medicine. For example, the monthly OOP on medicines among NCD households in Iran, where roughly 18% of NCD households experience catastrophic spending, is USD 13.50, representing 36% of OOP on health. In Brazil this figure is USD 25.85, representing 46% of OOP on health. A large proportion of OOP is also made up by consultation fees, particularly in Sub-Saharan African countries. In Poland, 63% of OOP on health is spent on alternative medicine consultation fees.

Conclusions

Our findings echo the message shared by the Director General of the World Health Organization in 2018, that there is “no Universal Health Coverage without access to quality medicines”. Medicine costs impose a significant economic burden on NCD households in countries at all levels of development, highlighting the need to include essential medicines for NCDs in universal health coverage benefit packages.

Key messages

To achieve the goal of improved financial risk protection for NCDs we need to understand drivers of out-of-pocket spending among households with NCDs. Medicines are by far the largest driver of OOP in countries at all levels of development and require urgent attention to ensure universal health coverage.

EUPHA strategy 2020-2025: Achieving a triple A rating for health in Europe

The challenges we face are complex in nature, and require multidisciplinary and intersectoral action at different governance levels. Therefore, EUPHA will reinforce its two-tier approach. On the one hand, we will support our members in providing high quality and efficient public health and health care services in European countries, regions and local communities. On the other hand, we will advocate for health and support evidence-informed health policy-making at the international level. Stimulating and facilitating mutual learning and the exchange of knowledge and experiences across experts, members and countries will be an essential element of EUPHA’s approach. Not only with a focus on optimal support for our members, but also with an explicit focus on overcoming health inequalities within and between European countries.

Our new vision is to enable everyone in Europe to achieve the highest possible level of health by providing independent and authoritative analysis of the evidence, combined with targeted advocacy to achieve co-ordinated action by all key stakeholders. Our vision: builds on the commitments of our governments and international agencies to achieve the health-related Sustainable Development Goals;recognises the importance of placing Health in All Policies;draws on the Vienna Declaration to embrace the entire range of health determinants, including the biological, social, environmental, occupational, political, and commercial, the health care system, and everything that influences the health of our planet.

Our mission will be: To ensure that there is a strong evidence base, built on sustained investments in data, research capacity, and knowledge translation in all parts of Europe that can inform policies that impact on health;To identify, develop, and advocate for actionable policy recommendations to improve health;andTo support capacity-building and collaborations that can achieve public health action.

Clinical and policy contexts for cancer care: Evidence from Denmark, Ireland and Ontario (Canada)

Background

We know there are large differences in cancer survival between countries. We know much less about why they exist and persist. In the International Cancer Benchmarking Partnership, we are seeking to understand the influences on patient journey in different countries. In this study we explore how health system factors impact on cancer care in Denmark, Ireland, and Ontario (Canada) to identify common themes, national specificities, and messages for other health care providers.

Methods

We systematically analysed (i) cancer policy and strategy documents from the three jurisdictions, published between 1995-2014 (n = 20) and (ii) interviews with key informants representing government, health services providers, professional bodies and patient organisations (n = 25). We thematically analysed both datasets using NVivo.

Results

Five themes emerged from the document review and were confirmed by interview: governance, quality assurance, service delivery, infrastructure and workforce. All three jurisdictions introduced a designated organisation to lead, monitor and, in Ontario, fund cancer services. Reducing wait times was prioritized, with the expansion of diagnostic capacity from the 2000s, for example. Concentrating services into fewer specialist centres was widely viewed as crucial for improving survival for some cancers. Yet policy intent was not always successfully realised on the ground, with lack of sustained investment, organisational barriers or logistical challenges impeding implementation. Jurisdictions face particular challenges maintaining and upgrading infrastructure and equipment, and recruiting and retaining critical staff, specifically in radiology and primary care.

Conclusions

Cancer care is complex and understanding the interrelationships between factors acting at different levels of the health system is important to improve outcomes. Continued investment in infrastructure and people will be essential.

Key messages

Countries face common challenges in creating health systems that optimise cancer outcomes. Sustained investment in equipment and human resources will be critical to optimise cancer care and survival.

Vaccination programmes and health systems in the European Union. Report of the Expert Panel on effective ways of investing in Health

Background

Vaccination is one of the most cost-effective public health interventions available and the main tool for primary prevention of communicable diseases. However, the EU is facing increasing outbreaks of vaccine preventable diseases, while some fatal cases of measles and diphtheria have been reported.

Methods

The presented report is based on the work of the Expert Panel on effective ways of investing in Health, which was informed by a literature review on the main factors (enablers and obstacles) influencing vaccination uptake.

Results

Obstacles to vaccination coverage include individuals’ and parents’ concerns or fears about vaccine safety and side effects, lack of trust, social norms, exposure to rumours and myths undermining confidence in vaccines, failure by some healthcare providers to counter these myths and provide evidence-informed advice, access barriers (e.g. poor availability, co-payments), and failure to understand the underlying mechanisms that decrease vaccination confidence. Enablers include sources of reliable information about vaccination, exposure to positive media messages, building trust in institutions and providers, building confidence in vaccination, easy access and availability to healthcare services, ease of administration, active involvement and engagement by healthcare providers, and targeting of high-risk groups.

Conclusions

There is a range of policy options that countries can implement to increase vaccination coverage. Communication strategies about the benefits of vaccination are important but need to be combined with opportunities for dialogue with vaccine hesitant groups and participatory approaches. These strategies need to be targeted not only at the uninformed (i.e. the lack of information) but also at the misinformed (when the information is incorrect) or disinformed (when information is spread with the intention to deceive).

The changing context of public health in Europe

From a public health perspective there is much to celebrate. Europe enters the third decade of the 21st century with a population that has never been healthier. Advances in knowledge, from basic sciences to public health, have transformed our ability to tackle the diseases that afflict our populations. It would be easy to become complacent. Yet, at the same time, our world is transforming rapidly and profoundly. Changing demographics, globalization, technological developments, climate change, shifting public opinions on the value of scientific evidence, a political arena that increasingly seems to focus on highlighting differences rather than looking for common ground: all these trends result in massive and complex societal challenges, which will place great strain on our public health and health care services. In addition, deep and persistent health inequalities within and between countries continue to demand action. New threats (e.g. fake news) are surfacing, old threats (e.g. measles and TB) are coming back and EUPHA and its members need to adapt. This presentation will survey the changing public health landscape in Europe and globally, highlighting key issues for EUPHA to address.

Compared to whom? Reference groups in socio-economic comparisons and self-reported health

Background

The association between socio-economic position and health is believed to be mediated, in part, by psycho-social comparison of one’s situation to that of others. But with who? Possibilities include family, friends, elites, or even those in other countries or in previous times. So far, there has been almost no research on whether the reference point matters.

Methods

We take advantage of a comparative data set that, uniquely, allows us to ask this question. The Life in Transition Survey was conducted in four Southern European and 30 Central and Eastern European and Eurasian countries. We sought differences in the probability of good self-reported health among those using different reference groups, including own family, friends and neighbours, domestic elites, people living in other countries and, those living prior to the major politico-economic transition. We used multivariable and multilevel mixed-effects Poisson regressions and estimated treatment effects via the regression adjustment of Poisson models.

Results

In most cases the choice of reference group did not matter but in some it did. Among men in Eastern European and Eurasian societies, those who compared themselves to their parents and their own families before the start of transition were less likely to report good health compared to those who did not compare their own economic situation with any specific reference group.

Conclusions

For some individuals, the choice of who to compare one’s situation with does seem to matter, pointing to an area for future investigation in research on psycho-social determinants of health.

Key messages

We found no difference in self-reported health between those who compare their situation with friends and neighbours, domestic elites, and people living in other countries. In post-communist countries, those who compared their situation to that of their parents and their own situation before the politico-economic transition were less likely to report good health.

P1738Pre-hospital delay in patients with suspected myocardial infarction: a prospective observational study in the Russian Federation

Background

Russia has one of the highest mortality rates from cardiovascular disease (CVD) in the world. For patients with acute myocardial infarction (AMI), longer pre-hospital delays are associated with increased complications and mortality.

Purpose

Identify risk factors for prolonged pre-hospital delay and its components (patient decision time delay and transport time delay) in the Russian Federation for AMI patients.

Methods

A total of 1128 hospitalised patients with suspected AMI were recruited in a prospective observational study with a representative sample of suspected AMI patients from 16 hospitals in 13 regions of Russia. Data were collected from both patient questionnaires and clinical records, 251 patients were excluded due to missing data and/or having MI while already hospitalised (n=6). Pre-hospital delays analysed include total pre-hospital delay ≥2hrs, patient decision time (≥1 hr) and transport time (≥1). Logistic regression models were used to identify patient (sociodemographic, socioeconomic, previous medical history), symptom and admission related predictors of prolonged delays.

Results

The median total pre-hospital delay was 4.83 hrs (IQR 2.64–10.82), decision time 1.25 hrs (IQR 0.38–4.5), and transport time 2.03 hrs (IQR 1.23–4.5). No age or sex differences were found across total, decision or transport delay. The odds of admission within 2 hours from symptom onset (total prehospital delay) significantly decreased with poorer wealth status, indirect route to hospital (first medical contact elsewhere) and symptom onset between 12–6am. Additionally, taking aspirin was associated with lower odds of arriving within 2hrs. Whilst symptom presentation and co-morbidity was not significantly associated with total delay, patients who correctly associated symptoms to a heart problem were more likely to reach the hospital within 2 hours (OR1.65, 95% CI 1.03–2.62). Odds of transport delay >1hr were significantly greater for patients travelling indirectly but also significantly lower for male patients. Odds of decision time >1 hr were significantly greater among patients that did not attribute their symptoms to a heart problem and patients with symptoms starting overnight (12–6am). Sociodemographic, socioeconomic and comorbid status were not significantly associated with decision time.

Conclusion

Pre-hospital delay in the Russian Federation is protracted, particularly when patients travel indirectly to their definitive health facility. Symptom characteristics (time of onset and attribution to heart) are important for all components of pre-hospital delay in the Russian Federation. There is initial evidence that male patients experience reduced transport times, but further analyses are required to understand why. Tractable areas for improvement exist; reducing patient decision time and increasing use of EMS.

Acknowledgement/Funding

Ministry of Health and Care Services, Norway, Norwegian Institute of Public Health, The University of Tromsø - Norway, the Wellcome Trust

Assessing the Impact of Electronic Health Record Interventions on Hepatitis B Screening and Vaccination

BACKGROUND

Hepatitis B virus (HBV) infection is a major health disparity between Asian Americans, Native Hawaiians, and Pacific Islanders compared with other racial/ethnic groups in the U.S.

AIMS

Our aims were to determine the effectiveness of an electronic health record (EHR) data-driven clinical intervention to improve HBV screening and vaccination rates at a community health center primarily serving Asian American patients.

METHODS

Using a community-engaged approach, we conducted a study to compare the differences in screening and vaccination rates for 6,429 patient encounters before and after implementation of the EHR intervention. A multivariable logistic regression analysis was conducted to estimate the effect of the intervention.

RESULTS

Analyses indicated that patients who visited the clinic after implementing the EHR intervention were more likely to be screened (OR=1.8, p<.001) and vaccinated (OR=2.8, p<.001) for hepatitis B.

CONCLUSIONS

Electronic health record interventions implemented using a community-engaged approach may improve delivery of appropriate care to patients at risk for hepatitis B in a community health setting.

Population uptake and effectiveness of test-and-treat antiretroviral therapy guidelines for preventing the global spread of HIV: an ecological cross-national analysis

OBJECTIVES

Although the benefits of adopting test-and-treat antiretroviral therapy (ART) guidelines that recommend initiation of ART regardless of CD4 cell counts have been demonstrated at the individual level, there is uncertainty about how this translates to the population level. Here, we explored whether adopting ART guidelines recommending earlier treatment initiation improves population ART access and viral suppression and reduces overall disease transmission.

METHODS

Data on ART initiation guidelines and treatment coverage, viral suppression, and HIV incidence from 37 European and Central Asian countries were collected from the European Centre for Disease Prevention and Control and the Global HIV Policy Watch and HIV 90-90-90 Watch databases. We used multivariate linear regression models to quantify the association of ART initiation guidelines with population ART access, viral suppression, and HIV incidence, adjusting for potential confounding factors.

RESULTS

Test-and-treat policies were associated with 15.2 percentage points (pp) [95% confidence interval (CI) 0.8-29.6 pp; P = 0.039] greater treatment coverage (proportion of HIV-positive people on ART) compared with countries with ART initiation at CD4 cell counts ≤ 350 cells/μL. The presence of test-and-treat policies was associated with 15.8 pp (95% CI 2.4-29.1 pp; P = 0.023) higher viral suppression rates (people on ART virally suppressed) compared with countries with treatment initiation at CD4 counts ≤ 350 cells/μL. ART initiation at CD4 counts ≤ 500 cells/μL did not significantly improve ART coverage compared to initiation at CD4 counts ≤ 350 cells/μL but achieved similar degrees of viral suppression as test-and-treat.

CONCLUSIONS

Test-and-treat was found to be associated with substantial improvements in population-level access to ART and viral suppression, further strengthening evidence that rapid initiation of treatment will help curb the spread of HIV.

Early post-operative outcomes of plate versus nail fixation for humeral shaft fractures

INTRODUCTION

This study was designed to measure early postoperative outcomes of plate vs. nail fixation for humeral shaft fractures.

PATIENTS AND METHODS

Patients ≥18 years who underwent plate or nail fixation for low-energy humeral shaft fractures between 2005-2016 were identified from the National Surgical Quality Improvement Program (NSQIP). Multivariable regression was used to compare postoperative outcomes using propensity score adjustment to account for differences between fixation groups. Variables included in the propensity score were age, American Society of Anesthesiologists (ASA) class, hypertension, steroid use, cancer, functional status, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and sex.

RESULTS

Plate fixation was used in 1418 patients (70.6%), while nail fixation was used in 591 (29.4%). Patients undergoing nail fixation were more likely to be older, have a higher American Society of Anesthesiologists (ASA) class, and have comorbidities. Mean operative time was statistically longer in the plate fixation group (130 +/-62 min vs. 102 +/-54 min). After propensity score adjustment, type of fixation was not a significant predictor of major or minor complications, length of stay, or readmission. However, nail fixation was a significant predictor of mortality following propensity score adjustment (OR 3.15, 95% Confidence interval 1.26-7.85).

CONCLUSION

Patients undergoing intramedullary nail fixation tended to be older patients with more comorbidities, suggesting that surgeons are selecting nail fixation in patients who may not be ideal surgical candidates. Although LOS, complications, and readmission rates were higher in the nail group, this difference was not statistically significant following propensity score adjustment. However, nail fixation remained an independent predictor of 30-day mortality following adjustment. This suggests that nail fixation may not be a safer surgical option in patients with multiple medical co-morbidities and low-energy humeral shaft fractures.

Amenable mortality in the EU-has the crisis changed its course?

Background

Did the global financial crisis and its aftermath impact upon the performance of health systems in Europe? We investigated trends in amenable and other mortality in the EU since 2000 across 28 EU countries.

Methods

We use WHO detailed mortality files from 28 EU countries to calculate age-standardized deaths rates from amenable and other causes. We then use joinpoint regression to analyse trends in mortality before and after the onset of the economic crisis in Europe in 2008.

Results

Amenable and other mortality have declined in the EU since 2000, albeit faster for amenable mortality. We observed increases in amenable mortality following the global financial crisis for females in Estonia [from -4.53 annual percentage change (APC) in 2005-12 to 0.03 APC in 2012-14] and Slovenia (from -4.22 APC in 2000-13 to 0.73 in 2013-15) as well as males and females in Greece(males: from -2.93 APC in 2000-10 to 0.01 APC in 2010-13; females: from -3.48 APC in 2000-10 to 0.06 APC in 2010-13). Other mortality continued to decline for these populations. Increases in deaths from infectious diseases before and after the crisis played a substantial part in reversals in Estonia, Slovenia and Greece.

Conclusion

There is evidence that amenable mortality rose in Greece and, among females in Estonia and Slovenia. However, in most countries, trends in amenable mortality rates appeared to be unaffected by the crisis.

Injury and depression among 212 039 individuals in 40 low- and middle-income countries

AIMS

Although injuries have been linked to worse mental health, little is known about this association among the general population in low- and middle-income countries (LAMICs). This study examined the association between injuries and depression in 40 LAMICs that participated in the World Health Survey.

METHODS

Cross-sectional information was obtained from 212 039 community-based adults on the past 12-month experience of road traffic and other (non-traffic) injuries and depression, which was assessed using questions based on the World Mental Health Survey version of the Composite International Diagnostic Interview. Multivariable logistic regression analysis and meta-analysis were used to examine associations.

RESULTS

The overall prevalence (95% CI) of past 12-month traffic injury, other injury, and depression was 2.8% (2.6-3.0%), 4.8% (4.6-5.0%) and 7.4% (7.1-7.8%), respectively. The prevalence of traffic injuries [range 0.1% (Ethiopia) to 5.1% (Bangladesh)], and other (non-traffic) injuries [range 0.9% (Myanmar) to 12.1% (Kenya)] varied widely across countries. After adjusting for demographic variables, alcohol consumption and smoking, the pooled OR (95%CI) for depression among individuals experiencing traffic injury based on a meta-analysis was 1.72 (1.48-1.99), and 2.04 (1.85-2.24) for those with other injuries. There was little between-country heterogeneity in the association between either form of injury and depression, although for traffic injuries, significant heterogeneity was observed between groups by country-income level (p = 0.043) where the pooled association was strongest in upper middle-income countries (OR = 2.37) and weakest in low-income countries (OR = 1.46).

CONCLUSIONS

Alerting health care providers in LAMICs to the increased risk of worse mental health among injury survivors and establishing effective trauma treatment systems to reduce the detrimental effects of injury should now be prioritised.

Continuous quality improvement methodology: a case study on multidisciplinary collaboration to improve chlamydia screening

This article illustrates quality improvement (QI) methodology using an example intended to improve chlamydia screening in women. QI projects in healthcare provide great opportunities to improve patient quality and safety in a real-world healthcare setting, yet many academic centres lack training programmes on how to conduct QI projects. The choice of chlamydia screening was based on the significant health burden chlamydia poses despite simple ways to screen and treat. At the University of Michigan, we implemented a multidepartment process to improve the chlamydia screening rates using the plan-do-check-act model. Steps to guide QI projects include the following: (1) assemble a motivated team of stakeholders and leaders; (2) identify the problem that is considered a high priority; (3) prepare for the project including support and resources; (4) set a goal and ways to evaluate outcomes; (5) identify the root cause(s) of the problem and prioritise based on impact and effort to address; (6) develop a countermeasure that addresses the selected root cause effectively; (7) pilot a small-scale project to assess for possible modifications; (8) large-scale roll-out including education on how to implement the project; and (9) assess and modify the process with a feedback mechanism. Using this nine-step process, chlamydia screening rates increased from 29% to 60%. QI projects differ from most clinical research projects by allowing clinicians to directly improve patients' health while contributing to the medical science body. This may interest clinicians wishing to conduct relevant research that can be disseminated through academic channels.

Availability and Affordability of Medicines for the Treatment of Cardiovascular Diseases in Pharmacies in Six Regions of the Russian Federation

Aim. To evaluate the availability and affordability of medicines used to treat of cardiovascular diseases (CVD) in several regions of the Russian Federation with different climatic, geographic, economic and demographic characteristics. Material and methods. The study was conducted in 6 regional capitals, chosen to differ in geographically, economically, and demographically. In each city, 5 pharmacies providing free medicines to certain categories of citizens (beneficiaries) and 5 private pharmacies serving anyone were selected at random. Medicine availability was assessed in all pharmacies, along with price only in the private pharmacies. Data were obtained for both original drug and appropriate generics. A list of 25 of the most frequently prescribed medicines for cardiovascular diseases was compiled. Results. Some general findings emerged. With the existence of a generic drug, the original drug was not available in the pharmacy supplying beneficiaries. Diuretics, as well as some ACE inhibitors, are not available in a number of pharmacies for beneficiaries. Enalapril in most licensed pharmacies is represented by generics, lisinopril in a number of cities is represented by both the original drug and generics. The presence of sartans was much lower than ACE inhibitors. Bisoprolol was most common beta-blocker. Calcium antagonists: if amlodipine was present in all licensed pharmacies, at list as generic, then nifedipine was not available in many licensed pharmacies. Among antiplatelet agents, aspirin was available in most pharmacies, and clopidogrel was mostly represented by generics. As for statins, only simvastatin could be found in almost all pharmacies. When analyzing the cost of drugs in licensed pharmacies, it was found that drugs containing furosemide are the cheapest among generics – about 17 rubles. The most expensive treatment with generics of rosuvastatin – about 4,374 rubles a month. The most expensive original medicine was also rosuvastatin – about 4,500 rubles for 30 tablets, the cheapest – the original drug of furosemide – about 35 rubles. On average, the cost of CVD treatment with major classes of drugs, including ACE inhibitor, beta-blocker, antiplatelet drug and statin, is 1,921.9 rubles per month. Conclusion. The basic cardiovascular medicines were characterized by a relatively high availability in 6 regions of the Russian Federation included in the analysis both by the criterion of the availability of drugs and by the criterion of the minimum price.