Fixing drug supply and price problems is urgent: report

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 

Published in:

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Now Public News, India, India, India
CNS Stop-TB Initiative


  1. Muherman Harun28 March, 2011

    How we welcome the introduction of a rapid method to identify active TB.

    We will have to do our utmost and put more energy to cope with the extra burden of increased cases to avoid DR-MDR TB.

    1. We are grateful having the FDC tablets for sputum positive cases for free. We have the 4 FDC, but not the 3 FDC tablets meant for treating sputum negative cases. Minimal but active lung TB with negative sputum cases are to be treated with the complete regimen of 4 FDC tablets.

    2. While the 4 FDC tablets are provided for free, patients still have to pay for the solution for staining the sputum smears. The cost of just one sputum examination would approximately equal the cost of four low-price meals in the city. The staining solution had been provided free, but not any longer since a year or more.

    Above situation may discourage the physician to omit sputum examination if chest X ray already shows lesions suggestive of TB. This is obviously contradicting WHO/government policy.

    What is the situation in other high burden countries?

    Happy 30th WORLD TB Day!

    Muherman Harun
    Jakarta, Indonesia

  2. Fred Mwansa28 March, 2011

    This report is very important and thanks to the researchers who put this together. Drug and diagnostic pricing should be discussed because when in low income countries, which are also the high burden TB countries, those people who will not be able to afford drugs or diagnostics are the ones who are most vulnerable. In order to ensure that universal access to TB Care reaches those who are least likely to access existing services, we need to address all issues including pricing.

    Also when we talk about TB free by 2015 then this won't be met. We have lost a lot of our brothers and sisters because they were poor and unable to access existing services or care. Time is running out before we can optimally address TB and poverty and make the dream of universal access come true.

    Fred Mwansa

  3. Aries Setyawan28 March, 2011

    It is interesting to me is still early to learn about tuberculosis. I am currently doing more assistance to people with HIV as a Case Manager. see article above makes me sad, turned out to MDR treatment cost is very expensive. after reading the above I tried to find information to friends who every day monitoring the Px MDR in a town in Indonesia.

    Situation in Indonesia, If the patient has insurance provided by the government (especially the poor) then the treatment for free. And some district get a support from international donor.

    The concern now is if the funding support from the donor to a halt. Cost for a package of treatment to reach about 80 million rupiah, or about $ 9,000 a person.
    Currently, for Px get support for transport to medical care and nutrition every day during treatment (during the donor is still there).
    I think it is important to reduce the price of medicine as low as possible, so that the developing / poor countries can pay for citizens. I am very concerned with the position of Px into revictim because if prices remain high and patients are more and more and eventually the country was not ready with the financing of the Px is unable to get drugs and eventually died.

    Does compulsory license for this drug, such as ARVs?

    Aries Setyawan
    Salatiga - Indonesia

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