Availability, price and affordability of anti-tuberculosis drugs in Europe: a TBNET survey.
Data on availability and cost of anti-tuberculosis (TB) drugs in relation to affordability at national level are scarce. We performed a cross-sectional study on availability and cost of anti-TB drugs at major TB-reference centres in 37 European countries. Costs of standardised treatment regimens used for pan-sensitive TB, multidrug-resistant (MDR) TB, pre-extensively drug-resistant (XDR) TB, and XDR-TB were compared using a purchasing power analysis. Affordability was evaluated in relation to monthly national gross domestic products per capita (GDP). At least one second-line injectable and either moxifloxacin or levofloxacin were available in all countries. Linezolid and clofazimine were available in 79% and 46% of the countries, respectively. Drug cost for XDR-TB was three-times more expensive than those for MDR-TB. The average price of treatment for pan-sensitive TB represented a maximum of 8.5% of the monthly GDP across countries, while for standard MDR-TB treatment this was <30% in only six countries and more than 100% in four countries. Treatment of XDR-TB represented more than 100% of a month's GDP in all countries where the regimen was available. High cost and limited availability of drugs for treatment of drug-resistant TB, particularly beyond resistance to first-line drugs, are a major impediment to successful TB control in Europe.
Division of Clinical Infectious Diseases, German Center for Infection Research (DZIF) Clinical Tuberculosis Unit, Research Center, Borstel, Germany Department of Medicine, University of Namibia School of Medicine, Windhoek, Namibia Both authors contributed equally to the manuscript.
Gunar
G
Günther
Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK Both authors contributed equally to the manuscript.
Gabriela B
GB
Gomez
Division of Clinical Infectious Diseases, German Center for Infection Research (DZIF) Clinical Tuberculosis Unit, Research Center, Borstel, Germany Department of Medicine, University of Namibia School of Medicine, Windhoek, Namibia.
Christoph
C
Lange
Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.
Stephan
S
Rupert
Frank
F
van Leth
D000995:Antitubercular Agents / Q000191:economics* / Q000494:pharmacology / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D016527:Drug Costs / Q000706:statistics & numerical data*; D005062:European Union; D054908:Extensively Drug-Resistant Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006295:Health Resources; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D008297:Male; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics
D000995:Antitubercular Agents