Abstract
ObjectiveTo investigate funding for the Global Drug Facility since 2001 and to analyse the facility’s influence on the price of high-quality tuberculosis drugs.MethodsData on the price of tuberculosis drugs were obtained from the Global Drug Facility for 2001 to 2012 and, for the private sector in 15 countries, from IMS Health for 2002 to 2012. Data on funding of the facility were also collected.FindingsQuality-assured tuberculosis drugs supplied by the Global Drug Facility were generally priced lower than drugs purchased in the private sector. In 2012, just three manufacturers accounted for 29.9 million United Stated dollars (US$) of US$ 44.5 million by value of first-line drugs supplied. The Global Fund to Fight AIDS, Tuberculosis and Malaria provided 73% (US$ 32.5 million of US$ 44.5 million) and 89% (US$ 57.8 million of US $65.2 million) of funds for first- and second-line drugs, respectively. Between 2010 and 2012, the facility’s market share of second-line tuberculosis drugs increased from 26.1% to 42.9%, while prices decreased by as much as 24% (from US$ 1231 to US$ 939). Conversely, the facility’s market share of first-line drugs fell from 37.2% to 19.2% during this time, while prices increased from US$ 9.53 to US$ 10.2.ConclusionThe price of tuberculosis drugs supplied through the facility was generally less than that on the private market. However, to realize its full potential and meet the needs of more tuberculosis patients, the facility requires more diverse and stable public funding and greater flexibility to participate in the private market.
Highlights
Tuberculosis remains a global public health concern
The patents have expired on many tuberculosis drugs, the power of individual low-income countries with a high disease burden to negotiate cheaper treatment is limited
The proportion of the Global Drug Facility’s funding that came from the Global Fund to Fight AIDS, Tuberculosis and Malaria increased over time: in 2012, it was 73% (US$ 32.5 million of US$ 44.5 million) and 89% (US$ 57.8 million of US$ 65.2 million) for first- and second-line drugs, respectively
Summary
In 2013, there were an estimated 9 million incident cases worldwide, 480 000 of which involved multidrug-resistant tuberculosis.[1] For tuberculosis as well as other conditions, disease control depends on more than the existence of curative treatment – it depends on the drug supply, which is mediated by the pharmaceutical market.[2,3,4,5,6,7] disease control is profoundly influenced by the functioning of this market, in resource-poor settings with a high disease burden. Despite the existence of international quality-assurance standards, tuberculosis drugs are often either substandard or counterfeit.[8,9,10] The use of substandard drugs reduces the chance of successful treatment and promotes the emergence of drug-resistance.[11] the patents have expired on many tuberculosis drugs, the power of individual low-income countries with a high disease burden to negotiate cheaper treatment is limited. Second-line treatment for multidrug-resistant tuberculosis involves more protracted and complex chemotherapy and can cost a hundred times more than treating drug-sensitive tuberculosis.[12,13]
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