Abstract
BackgroundOwing toGiven the high costs of drugs to treat multi-drug resistant tuberculosis (MDR-TB), the Green Light Committee (GLC) initiative enables TB programs to procure quality-assured drugs at reduced prices. Despite price reductions, internationally quality assured (IQA) drugs can be more expensive than locally procured drugs. There is little evidence to inform decision-makers about whether IQA drugs are more effective than local drugs. This is the first study to compare outcomes between MDR-TB patients treated using IQA, and locally procured drugs in the same hospitals during the same time period.Methods/FindingsA retrospective cohort study was conducted in three hospitals across Pakistan. Data on baseline characteristics and treatment outcomes during the first six months of treatment were extracted from hospital records of adult culture-positive pulmonary MDR-TB patients starting treatment between January 2011 and June 2012. Two cohorts were defined: patients receiving IQA drugs, and patients receiving locally procured non-IQA drugs. Data were analysed using Kaplan-Meier curves and Cox proportional hazards regression. The primary outcome compared between cohorts was time to culture conversion. Of 231 patients, 90 were in the IQA and 141 in the non-IQA cohorts. Baseline characteristics were similar except for higher frequency of quinolone resistance in the IQA cohort. Overall, 193 patients (84%) culture converted. Culture conversion was not faster in the IQA cohort; the median time was 81 and 68 days in the IQA and non-IQA cohorts, respectively. Unadjusted and adjusted hazard ratios for culture conversion in IQA verses non-IQA cohorts were 0.82 (95%-CI, 0.62-1.10) and 0.95 (95%-CI, 0.66-1.36) respectively.ConclusionsUse of good quality, locally procured drugs can be effective in treating MDR-TB, may involve lower costs than using IQA drugs and could strengthen developing country drug quality assurance systems. This may be a suitable alternative in lieu of or whilst awaiting arrival of internationally procured medicines.
Highlights
Locally procured drugs can be effective in treating multi-drug resistant tuberculosis (MDR-TB), may involve lower costs than using internationally quality assured (IQA) drugs and could strengthen developing country drug quality assurance systems
Multi-drug resistant TB (MDR-TB), which is caused by strains of Mycobacterium tuberculosis resistant to both isoniazid and rifampicin, poses several challenges for National Tuberculosis Programs (NTPs)
A major barrier to provision of timely and effective treatment by NTPs is the high cost of quality-assured second line drugs (SLDs)
Summary
Multi-drug resistant TB (MDR-TB), which is caused by strains of Mycobacterium tuberculosis resistant to both isoniazid and rifampicin, poses several challenges for National Tuberculosis Programs (NTPs). A major barrier to provision of timely and effective treatment by NTPs is the high cost of quality-assured second line drugs (SLDs). The GLC initiative enables approved MDR-TB programs to access high quality second-line drugs at reduced prices through the Global Drug Facility (GDF)[4]. Owing toGiven the high costs of drugs to treat multi-drug resistant tuberculosis (MDR-TB), the Green Light Committee (GLC) initiative enables TB programs to procure quality-assured drugs at reduced prices. Internationally quality assured (IQA) drugs can be more expensive than locally procured drugs. There is little evidence to inform decision-makers about whether IQA drugs are more effective than local drugs This is the first study to compare outcomes between MDR-TB patients treated using IQA, and locally procured drugs in the same hospitals during the same time period
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