Size and Usage Patterns of Private TB Drug Markets in the High Burden Countries

Abstract

BackgroundTuberculosis (TB) control is considered primarily a public health concern, and private sector TB treatment has attracted less attention. Thus, the size and characteristics of private sector TB drug sales remain largely unknown.Methodology/Principal FindingsWe used IMS Health data to analyze private TB drug consumption in 10 high burden countries (HBCs), after first mapping how well IMS data coverage overlapped with private markets. We defined private markets as any channels not used or influenced by national TB programs. Private markets in four countries – Pakistan, the Philippines, Indonesia and India – had the largest relative sales volumes; annually, they sold enough first line TB drugs to provide 65–117% of the respective countries' estimated annual incident cases with a standard 6–8 month regimen. First line drug volumes in five countries were predominantly fixed dose combinations (FDCs), but predominantly loose drugs in the other five. Across 10 countries, these drugs were available in 37 (loose drug) plus 74 (FDCs) distinct strengths. There were 54 distinct, significant first line manufacturers (range 2–11 per country), and most companies sold TB drugs in only a single study country. FDC markets were, however, more concentrated, with 4 companies capturing 69% of FDC volume across the ten countries. Among second line drugs, fluoroquinolones were widely available, with significant volumes used for TB in India, Pakistan and Indonesia. However, certain WHO-recommended drugs were not available and in general there were insufficient drug volumes to cover the majority of the expected burden of multidrug-resistant TB (MDR-TB).Conclusions/SignificancePrivate TB drug markets in several HBCs are substantial, stable, and complicated. This calls for appropriate policy and market responses, including expansion of Public-Private Mix (PPM) programs, greater reach, flexibility and appeal of public programs, regulatory and quality enforcement, and expansion of public MDR-TB treatment programs.

‘They prefer hidden treatment': anti-tuberculosis drug-taking practices and drug regulation in Karakalpakstan

“…In addition, direct access to arbitrary use of TB drugs for 56 patients through the private market has been implicated in treatment failure and 57 development of drug resistance in high-burden countries. 4 For instance, in Tbilisi, Georgia, 58 TB drugs, including second-line agents used to treat MDR-TB, were widely available without 59 prescription at pharmacies. 5 Strategies to ensure effective drug management and supply 60 form a major component of the World Health Organisation Stop TB Strategy.…”

Tuberculosis case notification by private practitioners in Pune, India: how well are we doing?

“…[1][2][3][4] Studies on anti-tuberculosis drug sales in India estimate that the number of cases treated in the private sector alone exceeds estimated overall TB incidence. 5 Studies from Mumbai and elsewhere have shown poor diagnosis and treatment practices among practitioners in the private health sector that contribute to acquired drug resistance. [6][7][8][9][10] To reduce TB transmission and prevent the emergence of virtually incurable forms of drug-resistant TB, TB management in the private sector must be aligned with the international standards of TB care.…”

Exploring the evidence base for national and regional policy interventions to combat resistance

“…Lack of controls and checks on the quality of medicines being sold results in the supply of substandard agents. [51][52][53] A recent multicountry study found that in neighbouring India, 10.1% of first-line Isoniazid and Rifampicin samples tested were substandard. 54 While a number of factors are likely to contribute to the reported increase in number of XDR-TB cases from Pakistan 55 poor quality of TB drugs and inappropriate prescription have a significant role in driving resistance.…”