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Availability, price and affordability of anti-tuberculosis drugs in Europe: a TBNET survey

Gunar Günther, Gabriela B. Gomez, Christoph Lange, Stephan Rupert, Frank van Leth on behalf of the TBNET
European Respiratory Journal 2015 45: 1081-1088; DOI: 10.1183/09031936.00124614
Gunar Günther
1Division of Clinical Infectious Diseases, German Center for Infection Research (DZIF) Clinical Tuberculosis Unit, Research Center, Borstel, Germany
2Department of Medicine, University of Namibia School of Medicine, Windhoek, Namibia
5Both authors contributed equally to the manuscript
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Gabriela B. Gomez
3Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
4Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
5Both authors contributed equally to the manuscript
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Christoph Lange
1Division of Clinical Infectious Diseases, German Center for Infection Research (DZIF) Clinical Tuberculosis Unit, Research Center, Borstel, Germany
2Department of Medicine, University of Namibia School of Medicine, Windhoek, Namibia
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Stephan Rupert
3Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
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Frank van Leth
3Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
6For a list of TBNET contributors, see Acknowledgements section
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  • FIGURE 1
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    FIGURE 1

    Availability of selected drugs and treatment regimen. HRZE: isoniazid, rifampicin, pyrazinamide, ethambutol; SL-inj: second-line injection; FQ: fluoroquinolone; PAS: para-aminosalicylic acid; MDR: multidrug resistant; XDR: extensively drug resistant.

  • FIGURE 2
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    FIGURE 2

    Affordability of treatment regimens. GDP: gross domestic product. Square: preferred regimen; circle: alternative regimen; black: pan-sensitive; green: multidrug resistant; red: extensively drug resistant (XDR); blue: pre-XDRinj TB (multidrug-resistant tuberculosis with additional resistance to second-line injectable); purple: pre-XDRfq TB (multidrug-resistant tuberculosis with additional resistance to fluoroquninolone); H: high incidence (>100 per 100 000 people); M: medium incidence (15–100 per 100 000 people); L: low incidence (<15 per 100 000 people).

Tables

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  • TABLE 1 Preferred and alternative treatment regimens by resistance pattern
    Drug resistancePreferenceDuration (months)Regimen
    TypePattern
    SensitiveNonePreferred2HRZE
    4HR
    MDRIsoniazid and rifampicinPreferred8SL-inj, FQ, Pto/Eto, Cs/Trd, E, Z
    12FQ, Pto/Eto, Cs/Trd, E, Z
    Alternative8SL-inj, FQ, PAS, Cs/Trd, E, Z
    12FQ, PAS, Cs/Trd, E, Z
    Pre-XDRinjMDR + resistance against SL-injPreferred20FQ, Pto/Eto, Cs/Trd, Lzd, E, Z
    Alternative20FQ, PAS, Cs/Trd, Lzd, E, Z
    Pre-XDRfqMDR + resistance against FQsPreferred8SL-inj, Pto/Eto, Cs/Trd, Lzd, Cfz, E, Z
    12Pto/Eto, Cs/Trd, Lzd, Cfz, E, Z
    Alternative8SL-inj, PAS, Cs/Trd, Lzd, Cfz, E, Z
    12PAS, Cs/Trd, Lzd, Cfz, E, Z
    XDRMDR + resistance against SL-inj + FQsPreferred20Pto/Eto, Cs/Trd, Lzd, Cfz, Amx-Clav, Mero, E, Z
    Alternative20PAS, Cs/Trd, Lzd, Cfz, Amx-Clv, Mero, E, Z
    • MDR: multidrug-resistant; pre-XDRinj: MDR tuberculosis with additional resistance to second-line injectable; pre-XDRfq: MDR tuberculosis with aditional resistance to fluoroquinolone; H: isoniazid; R: rifampicin; Z: pyrazinamide; E: ethambutol; SL-inj: second-line injectable; FQ: fluoroquinolone; Pto/Eto: prothionamide/ethionamide; Cs/Trd: cycloserine/terizidone; PAS: para-aminosalicylic acid; Lzd: linezolid; Cfz: clofazimine; Amx–Clav: amoxicillin–clavulanic acid; Mero: meropenem.

  • TABLE 2 Average price per day treatment for individual drugs
    Treatment groupDrug name (route)Dose mg·day−1Cost
    EuroI$
    MeanMinMaxMeanMinMax
    Group 1Isoniazid (orally)3000.400.013.120.560.014.52
    Rifampicin (orally)6000.890.093.791.180.253.40
    Ethambutol (orally)12000.870.074.721.150.175.76
    Pyrazinamide (orally)20000.740.063.631.000.143.60
    Group 2Streptomycin (i.v./intramuscular)10002.870.1221.964.260.3326.78
    Amikacin (i.v.)75017.760.60131.8921.491.81141.82
    Capreomycin (i.v.)100045.952.67172.5566.154.67218.42
    Kanamycin (i.v.)10002.880.1715.985.350.5230.73
    Group 3Levofloxacin (orally)10004.180.1526.886.340.3240.21
    Moxifloxacin (orally)4003.861.1014.066.541.4116.63
    Group 4Para-aminosalicylate acid (orally)1200015.480.3234.5125.550.79103.00
    Prothionamide/ethionamide (orally)7506.360.0923.819.430.1939.31
    Cycloserine/terizidone (orally)75013.330.5839.5019.021.2757.29
    Group 5Clofazimine (orally)1001.600.124.312.380.179.76
    Linezolid (orally)60058.664.50108.1090.238.55244.82
    Amoxicillin-clavulanic acid (orally)1750/2502.060.2415.673.230.3123.04
    Meropenem (i.v.)300048.6914.61150.7972.8817.56237.34
  • TABLE 3 Average drug costs per full treatment regimen where available
    ResistanceRegimenCountries nCost
    EuroI$
    MeanMinMaxMeanMinMax
    Pan-sensitivePreferred37334411299448931164
    MDRPreferred3023 272211277 35431 715456579 247
    MDRAlternative2323 398313672 61834 656678178 083
    Pre-XDRinjPreferred2454 52324 34496 45878 04746 257181 739
    Alternative1958 37318 57198 27185 17135 287188 517
    Pre-XDRfqPreferred1667 34635 507106 73088 19961 261207 152
    Alternative1171 50629 734104 02395 27556 498213 930
    XDRPreferred1493 96256 028180 237123 93675 587329 104
    Alternative990 65765 031148 312124 88782 317335 882
    • MDR: multidrug resistant; pre-XDRinj: MDR tuberculosis with additional resistance to second-line injectable; pre-XDRfq: MDR tuberculosis with aditional resistance to fluoroquinolone.

Additional Files

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    • Christoph Lange
    • Gunar Günther
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    Availability, price and affordability of anti-tuberculosis drugs in Europe: a TBNET survey
    Gunar Günther, Gabriela B. Gomez, Christoph Lange, Stephan Rupert, Frank van Leth
    European Respiratory Journal Apr 2015, 45 (4) 1081-1088; DOI: 10.1183/09031936.00124614

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    Availability, price and affordability of anti-tuberculosis drugs in Europe: a TBNET survey
    Gunar Günther, Gabriela B. Gomez, Christoph Lange, Stephan Rupert, Frank van Leth
    European Respiratory Journal Apr 2015, 45 (4) 1081-1088; DOI: 10.1183/09031936.00124614
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