The first detailed study of the private tuberculosis (TB) drug market, published on May 4th, in the PLoS ONE journal, finds that the market is surprisingly large, and has irregular practices that could be driving treatment failures and contributing to the emergence of multidrug-resistant TB (MDR-TB).
The research, conducted by the TB Alliance and IMS Health, examined 10 high-burden countries (Bangladesh, China, India, Indonesia, Pakistan, Philippines, Russian Federation, South Africa, Thailand, and Vietnam) where 60 percent of the world’s TB burden is present and found the following:
- Previously, TB treatment was thought to take place primarily in the public sector. However, there is as much TB drug volume in the private sector as in the public sector, implying massive overtreatment and retreatment of the disease.
- More than one-third (35%) of all dosages of first-line TB drugs sold in the private sector fall outside national and international treatment recommendations. There were 111 different first-line TB drug dosages and combinations being sold in the private sector, compared to the 14 deemed necessary by WHO for rational treatment of children and adults. The chaos surrounding what should be standard treatment may be contributing to escalating rates of MDR-TB and further worsening of the TB epidemic.
- Relative to their TB burdens, India, Indonesia, Pakistan, and Philippines have particularly large private TB drug markets; the market in India alone is estimated to include enough drugs to treat more than 2 million cases.
- MDR-TB treatment rates are low within the private sector, showing that the private market has not stepped in to fill the growing gap in treatment for patients in need.
According to Dr. William Wells, Director of Market Access at the TB Alliance and lead author of the study, “The private sector is keeping alive the confusion that existed previously in the public sector. With this new baseline understanding of the TB drug market, we can no longer ignore the private sector’s critical role in the access equation for TB treatment.”
Both current drugs and new regimens, which are now in the latest stages of testing, need to be protected from the development of resistance. Some excellent examples of public-private collaborations (called public-private mix, or PPM) bring public sector treatment norms to private sector providers, but greater government and international support is needed for these efforts and for improved regulatory oversight and quality assurance of TB drugs.
TB kills nearly 2 million people each year, mostly in low and middle income countries. One of the drivers of the epidemic is the old and inadequate treatment. There have been no new TB drug classes for nearly 50 years and the current regimen takes 6-9 months, thus burdening health systems in resource-poor settings. Many patients are unable to complete their drug regimen, which leads to the development of MDR-TB, an emerging global health threat. The treatment for MDR-TB can take two years or longer, involves multiple drugs including injectables, and is much more expensive than the first-line treatment. According to WHO, there were 440,000 cases of MDR-TB in 2008. Even among those MDR-TB patients who were able to access MDR-TB treatment, at least a third still died.