Availability and costs of medicines for the treatment of tuberculosis in Europe

Gunar Günther(University of Bern), Lorenzo Guglielmetti(Inserm), Claude Leu(University of Bern), Christoph Lange(Baylor College of Medicine), Frank van Leth(Vrije Universiteit Amsterdam), Hasan Hafizi(Spitali Universitar Shefqet Ndroqi), Naira Khachatryan, Harut Aroyan, Eduard Kabasakalyan(National Statistical Service of the Republic of Armenia), Michael Knappik(Lenzing (Austria)), Alena Skrahina(Republican Scientific and Practical Centre of Pulmonology and Tuberculosis), Dzmitry Klimuk(Republican Scientific and Practical Centre of Pulmonology and Tuberculosis), Alena Nikolenka(Republican Scientific and Practical Centre of Pulmonology and Tuberculosis), Inge Muylle, Vladimir Milanov(Medical University of Sofia), Desislava Velkovska, Neli Tarinska, Elizabeta Bachiyska(National Center of Infectious and Parasitic Diseases), Mateja Janković Makek(University Hospital Centre Zagreb), Despo Pieridou(Nicosia General Hospital), Τώνια Αδαμίδη(Nicosia General Hospital), Nicos Nicolaou(Nicosia General Hospital), Martina Vašáková(Charles University), Mariia Sukholytka(Charles University), Emília Kopecká(Charles University), Dorte Bek Folkvardsen(Statens Serum Institut), Erik Svensson(Statens Serum Institut), Manfred Danilovitš(Tartu University Hospital), Tiina Kummik(Tartu University Hospital), Tuula Vasankari(University of Turku), Mathilde Fréchet-Jachym(AlterSanté), A. Nahmiash(AlterSanté), Tamar Togonidze(National Center for Tuberculosis and Lung Disease), Zaza Avaliani(National Center for Tuberculosis and Lung Disease), Inga Kinkladze(National Center for Tuberculosis and Lung Disease), Rusudan Aspindzelashvili(National Center for Tuberculosis and Lung Disease), Teona Bichashvili(National Center for Tuberculosis and Lung Disease), Gulnazi Losaberidze(National Center for Tuberculosis and Lung Disease), Tsitsino Merabishvili(National Center for Tuberculosis and Lung Disease), Barbara Kalsdorf(German Center for Infection Research), Κaterina Manika(Aristotle University of Thessaloniki), Karyofyllis Tsiakitzis(G. Papanikolaou General Hospital), Ágnes Bakos(Országos Korányi Tbc és Pulmonológiai Intézet), Tinna Rán Ægisdóttir(National University Hospital of Iceland), Guðrún Svanhvít Michelsen(National University Hospital of Iceland), Kristín Karlsdóttir(National University Hospital of Iceland), Anne-Marie McLaughlin(St. James's Hospital), Margaret Fitzgibbon(Central Statistics Office), Daniel Chemtob(Israel Ministry of Health), Luigi Ruffo Codecasa(Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda), Maurizio Ferrarese(Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda), Stefania Torri(Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda), Majlinda Gjocaj, Līga Kukša(Riga East University Hospital), Edita Davidavičienė(Vilnius University), Gil Wirtz(Centre Hospitalier de Luxembourg), Monique Perrin(Laboratoire National de Santé), Analita Pace Asciak(Ministry for Health), Dumitri Chesov(University Medical Center Groningen), Wiel de Lange(University Medical Center Groningen), Onno W. Akkerman(University Medical Center Groningen), Biljana Ilievska Poposka(Institute of public health of Republic of Macedonia), Ulrich Mack(Lovisenberg Diakonale Sykehus), Mogens Jensenius(Oslo University Hospital), Lajla Kvalvik(Oslo University Hospital), Anne Torunn Mengshoel(Norwegian Institute of Public Health), Katarzyna Kruczak(Krakow Cardiovascular Research Institute), Raquel Duarte(Universidade do Porto), Nadine Ribeiro, Elmira Ibraim(Institutul de Pneumoftiziologie "Marius Nasta"), Anna Kaluzhenina(Volgograd State Medical University), O.N. Barkanova(Volgograd State Medical University), Dragica Pešut(University of Belgrade), Ivan Solovič, Petra Svetina(University Clinic of Pulmonary and Allergic Diseases Golnik), María Luiza de Souza-Galvão(Vall d'Hebron Hospital Universitari), Joan-Pau Millet(Agència de Salut Pública de Catalunya), Xavi Casas, Montserrat Vives, Judith Bruchfeld(Karolinska University Hospital), Paulina Dalemo(Karolinska University Hospital), Jerker Jonsson(Public Health Agency of Sweden), Katrin Aeschbacher(University Hospital of Bern), Peter M. Keller(University of Bern), Şeref Özkara, Simon Tiberi(Queen Mary University of London), Christabelle Chen(Barts Health NHS Trust), Yana Terleeva(Ministry of Health), Andrii Dudnyk(National Pirogov Memorial Medical University, Vinnytsya)
Clinical Microbiology and Infection
August 10, 2022
10.1016/j.cmi.2022.07.026
Cited by 49Open Access
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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.

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