Availability and costs of medicines for the treatment of tuberculosis in Europe
Gunar Günther, Lorenzo Guglielmetti, Claude Leu, Christoph Lange, Frank van Leth, Hasan Hafizi, Naira Khachatryan, Harut Aroyan, Eduard Kabasakalyan, Michael Knappik, Alena Skrahina, Dzmitry Klimuk, Alena Nikolenka, Inge Muylle, Vladimir Milanov, Desislava Velkovska, Neli Tarinska, Elizabeta Bachiyska, Mateja Janković Makek, Despo Pieridou, Τώνια Αδαμίδη, Nicos Nicolaou, Martina Vašáková, Mariia Sukholytka, Emília Kopecká, Dorte Bek Folkvardsen, Erik Svensson, Manfred Danilovitš, Tiina Kummik, Tuula Vasankari, Mathilde Fréchet-Jachym, A. Nahmiash, Tamar Togonidze, Zaza Avaliani, Inga Kinkladze, Rusudan Aspindzelashvili, Teona Bichashvili, Gulnazi Losaberidze, Tsitsino Merabishvili, Barbara Kalsdorf, Κaterina Manika, Karyofyllis Tsiakitzis, Ágnes Bakos, Tinna Rán Ægisdóttir, Guðrún Svanhvít Michelsen, Kristín Karlsdóttir, Anne-Marie McLaughlin, Margaret Fitzgibbon, Daniel Chemtob, Luigi Ruffo Codecasa, Maurizio Ferrarese, Stefania Torri, Majlinda Gjocaj, Līga Kukša, Edita Davidavičienė, Gil Wirtz, Monique Perrin, Analita Pace Asciak, Dumitri Chesov, Wiel de Lange, Onno W. Akkerman, Biljana Ilievska Poposka, Ulrich Mack, Mogens Jensenius, Lajla Kvalvik, Anne Torunn Mengshoel, Katarzyna Kruczak, Raquel Duarte, Nadine Ribeiro, Elmira Ibraim, Anna Kaluzhenina, O.N. Barkanova, Dragica Pešut, Ivan Solovič, Petra Svetina, María Luiza de Souza-Galvão, Joan-Pau Millet, Xavi Casas, Montserrat Vives, Judith Bruchfeld, Paulina Dalemo, Jerker Jonsson, Katrin Aeschbacher, Peter M. Keller, Şeref Özkara, Simon Tiberi, Christabelle Chen, Yana Terleeva, Andrii Dudnyk
Abstract
OBJECTIVES: To evaluate the access to comprehensive diagnostics and novel antituberculosis medicines in European countries. METHODS: We investigated the access to genotypic and phenotypic Mycobacterium tuberculosis drug susceptibility testing and the availability of antituberculosis drugs and calculated the cost of drugs and treatment regimens at major tuberculosis treatment centres in countries of the WHO European region where rates of drug-resistant tuberculosis are the highest among all WHO regions. Results were stratified by middle-income and high-income countries. RESULTS: Overall, 43 treatment centres from 43 countries participated in the study. For WHO group A drugs, the frequency of countries with the availability of phenotypic drug susceptibility testing was as follows: (a) 75% (30/40) for levofloxacin, (b) 82% (33/40) for moxifloxacin, (c) 48% (19/40) for bedaquiline, and (d) 72% (29/40) for linezolid. Overall, of the 43 countries, 36 (84%) and 24 (56%) countries had access to bedaquiline and delamanid, respectively, whereas only 6 (14%) countries had access to rifapentine. The treatment of patients with extensively drug-resistant tuberculosis with a regimen including a carbapenem was available only in 17 (40%) of the 43 countries. The median cost of regimens for drug-susceptible tuberculosis, multidrug-resistant/rifampicin-resistant tuberculosis (shorter regimen, including bedaquiline for 6 months), and extensively drug-resistant tuberculosis (including bedaquiline, delamanid, and a carbapenem) were €44 (minimum-maximum, €15-152), €764 (minimum-maximum, €542-15152), and €8709 (minimum-maximum, €7965-11759) in middle-income countries (n = 12) and €280 (minimum-maximum, €78-1084), €29765 (minimum-maximum, €11116-40584), and €217591 (minimum-maximum, €82827-320146) in high-income countries (n = 29), respectively. DISCUSSION: In countries of the WHO European region, there is a widespread lack of drug susceptibility testing capacity to new and repurposed antituberculosis drugs, lack of access to essential medications in several countries, and a high cost for the treatment of drug-resistant tuberculosis.