Tuberculosis Drug Issues: Prices, Fixed Dose Combination Products and Second Line Drugs

Summary of paper presented to North American regional meeting of the International Union against Tuberculosis and Lung Disease Vancouver February 26th 2000 by Richard Laing and Kelly McGoldrick

Access to tuberculosis drugs depends on multiple factors. Selection of a standard list of TB drugs to procure is the first step. This paper reviews the advantages and disadvantages of procuring and using Fixed Dose Combination (FDC) products for both the intensive and continuation phases of treatment. The major advantages are to prevent the emergence of resistance, to simplify logistic management and to reduce costs. The major disadvantage is the need for the manufacturers to assure the quality of these FDC’s by bioavailability testing.

The paper reports on the inclusion of second line TB drugs in the 1999 WHO Essential Drug List (EDL). The need to ensure that these drugs are used within established DOTS-Plus programs is stressed.

The price of TB drugs is determined by many factors including producer prices, local taxes and duties as well as mark-ups and fees. In this paper TB drug prices for both the public and private sectors from developed and developing countries are reported. Price trends over time are also reported. The key findings of this study are that TB drug prices have generally declined in developing countries while they have increased in developed countries both for the public and private sectors. Prices vary between countries with the US paying as much as 95 times the price paid in a specific developing country. The price of public sector first line TB drugs vary little between countries though differences do exist due to the procurement methods used. The price of tuberculin, a diagnostic agent, has increased dramatically in the US with substantial inter country variations in price.

The paper suggests that further research is necessary to identify the reasons for the price disparities and changes over time and suggests method which can be used by NTP managers to ensure availability of quality assured TB drugs at low prices.