Private TB drug market might be fueling drug resistance, treatment failures

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The surprisingly large and irregular practices of the private tuberculosis (TB) drug market could be driving treatment failures and the emergence of multi-drug resistance (MDR), according to a new report in the journal PLoS ONE

The study found the private TB drug market is now just as big as the public market, whereas previously TB treatment was thought to take place primarily in the public sector. Across 10 high-burden countries – home to 60 percent of the world’s TB cases – there is as much TB drug volume in the private sector as in the public sector. The report found 111 different first-line TB drug dosages and combinations in the private sector, compared to the 14 that are deemed necessary by the Stop TB Partnership’s Global Drug Facility. More than one third of all private sector dosages of first-line TB drugs did not correspond to national and international treatment recommendations.

Since novel TB drug regimens are being developed and will be rolled out soon, something that hasn’t happened in several decades, this study aimed to understand the true make up of the entire market and plan for the introduction and maximum impact of the new TB regimens, according to a video featuring Dr. William Wells, lead author of the study and director of Market Access at the TB Alliance.

“Any resulting drug misuse could be responsible for many treatment failures and for escalating the emergence of MDR-TB, which is further worsening the TB epidemic,” according to a press release from the TB Alliance (the Global Alliance for TB Drug Development), who co-conducted the research with IMS Health, a healthcare market research and consulting-services firm.

The study, the first of its kind of the private TB drug market, found that nearly equal amounts of TB drugs are dispensed in the public and private sectors. In India, Indonesia, Pakistan, and the Philippines, four of the biggest high-burden countries, the private sector is particularly large, with enough TB drugs sold to treat essentially all incident TB cases in those countries with a full TB drug regimen.  Since this does not take into account the 60 to 80 percent coverage by the public sector, “significant overuse of TB drugs” is implied, according to the release.

“Most countries covered in this study have public-private mix programmes for TB care… Private providers following best practices should be supported through accreditation and access to free TB drugs from the public sector, while those not doing so should be regulated,” said Director of the Stop TB Partnership at the World Health Organization Mario Raviglione.

“We must dedicate more efforts toward ensuring rational prescribing in the private sector if we are to protect both current drugs and new regimens, which are now in the latest stages of testing, form the development of resistance,” Wells said in the release. There were 440,000 cases of MDR-TB in 2008 according to the World Health Organization.

The study also highlighted the lack of MDR-TB treatment in both public and private sectors, with few receiving treatment in the public sector and the private sector having the capacity to cover only approximately one to 10 percent of MDR-TB patients with “anything approaching a full” treatment regimen. The drugs are available so there is potential for the private sector to expand quickly into this area, Wells said. With new rapid diagnostic technology such as the Gene Xpert becoming increasingly available, Wells warned that the market for MDR-TB treatment might expand rapidly and now is the appropriate time to address the private market issue.

The study article, entitled “Size and Usage Patterns of Private TB Drug Markets in the High-Burden Countries,” is now available online.

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