title: The number of privately treated tuberculosis cases in India: an estimation from drug sales data.
abstract: BACKGROUND
  Understanding the amount of tuberculosis managed by the private sector in India is crucial to understanding the true burden of the disease in the country, and thus globally. In the absence of quality surveillance data on privately treated patients, commercial drug sales data offer an empirical foundation for disease burden estimation.
  
  
  METHODS
  We used a large, nationally representative commercial dataset on sales of 189 anti-tuberculosis products available in India to calculate the amount of anti-tuberculosis treatment in the private sector in 2013-14. We corrected estimates using validation studies that audited prescriptions against tuberculosis diagnosis, and estimated uncertainty using Monte Carlo simulation. To address implications for numbers of patients with tuberculosis, we explored varying assumptions for average duration of tuberculosis treatment and accuracy of private diagnosis.
  
  
  RESULTS
  There were 17·793 million patient-months (95% credible interval 16·709 million to 19·841 million) of anti-tuberculosis treatment in the private sector in 2014, twice as many as the public sector. If 40-60% of private-sector tuberculosis diagnoses are correct, and if private-sector tuberculosis treatment lasts on average 2-6 months, this implies that 1·19-5·34 million tuberculosis cases were treated in the private sector in 2014 alone. The midpoint of these ranges yields an estimate of 2·2 million cases, two to three times higher than currently assumed.
  
  
  CONCLUSIONS
  India's private sector is treating an enormous number of patients for tuberculosis, appreciably higher than has been previously recognised. Accordingly, there is a re-doubled need to address this burden and to strengthen surveillance. Tuberculosis burden estimates in India and worldwide require revision.
  
  
  BACKGROUND
  Bill & Melinda Gates Foundation.
authors: MRC Centre for Outbreak Analysis and Modelling, School of Public Health, Imperial College London, London, UK. Electronic address: nim.pathy@imperial.ac.uk.
authors: Nimalan
authors: N
authors: Arinaminpathy
authors: IMS Health, New Delhi, India.
authors: Deepak
authors: D
authors: Batra
authors: Central TB Division, Government of India, New Delhi, India.
authors: Sunil
authors: S
authors: Khaparde
authors: IMS Health, New Delhi, India.
authors: Thongsuanmung
authors: T
authors: Vualnam
authors: IMS Health, New Delhi, India.
authors: Nilesh
authors: N
authors: Maheshwari
authors: IMS Health, New Delhi, India.
authors: Lokesh
authors: L
authors: Sharma
authors: World Health Organization, India Country Office, New Delhi, India.
authors: Sreenivas A
authors: SA
authors: Nair
authors: Bill & Melinda Gates Foundation, New Delhi, India.
authors: Puneet
authors: P
authors: Dewan
mesh_terms: D000995:Antitubercular Agents / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D007194:India / Q000453:epidemiology; D004364:Pharmaceutical Preparations / Q000191:economics*; D017149:Private Sector / Q000191:economics*; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents; D004364:Pharmaceutical Preparations