A promising new diagnostic test will finally help detect more people with drug-resistant tuberculosis (DR-TB), increasing the urgency to solve major problems around the pricing and supply of DR-TB medicines, according to a new report by the International Union Against Tuberculosis and Lung Disease (The Union), and international medical humanitarian organization Médecins Sans Frontières (MSF). DR-TB is on the rise, but less than 7% of 440,000 new cases each year receive treatment, and DR-TB kills 150,000 people annually. The treatment of DR-TB relies on old antibiotics, many of which have severe side effects, ranging from constant nausea to deafness, and must be taken as complex regimens – patients must take up to 17 pills every day for up to two years. However, these are the only drugs that exist today that can tackle DR-TB. The Union's and MSF’s report shows that these drugs are riddled with persistent supply and price problems that must be urgently addressed.
"Patients have been stuck in a vicious circle – not enough people are diagnosed, and drug supply problems along with high prices stand in the way of putting more people on treatment," said Dr Tido von Schoen-Angerer, Executive Director of MSF's Campaign for Access to Essential Medicines. "The low demand for DR-TB drugs has made the market unattractive for producers, which is reinforcing supply and price problems."
This report examined medicines used to treat DR-TB according to the number of suppliers, quality assurance and price, based on information obtained from the Global Drug Facility and drug manufacturers. It found that four of the recommended medicines are available from only one quality-assured source. Relying on a sole supplier whose production could be disrupted or stopped at any time always carries a risk of dangerous treatment interruption for patients. For example, supplies of the injectable drug kanamycin were disrupted during 2010, leading to a temporary global stock out.
Additionally, the report found that several DR-TB medicines are very expensive, with prices for two drugs having increased by more than 600% and one drug by more than 800% over the last decade. A 24-month DR-TB treatment regimen can cost as much as USD 9,000 for one patient – 470 times more than the USD 19 per patient it costs to cure standard, drug-sensitive TB.
"Now that we have a new test that can detect DR-TB in less than two hours instead of three months, we're going to see many more people who will need reliable drug supplies to get cured," said Dr Jennifer Hughes of MSF in Khayelitsha, South Africa. MSF, along with the Union, is rolling out the new test in 15 countries this year. "We need to see some immediate action to resolve these problems and improve access to DR-TB drugs so that more people are started on treatment and transmission of this disease is reduced," said Dr. Hughes.
One way to kick start increased production of some of these drugs is for donors to guarantee purchase volumes for several years to producers upfront. Other mechanisms such as better forecasting of the mid- to long-term needs for DR-TB drugs are also needed to help attract more producers to the market, to improve supply security and increase competition that helps brings prices down.
"We have developed a model of managing DR-TB within the community that can be scaled up to allow increased access to treatment in high HIV prevalent settings. With faster diagnosis and better treatment models of DR-TB we need to fix the supply and price issues with DR-TB drugs. We also need to see new drugs developed," said Dr Hughes.
Bobby Ramakant - CNS
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