Cost and availability of drugs and treatment regimens and availability of drug resistance testing for tuberculosis in Europe

Abstract

Background: Access to comprehensive diagnostics and novel anti-tuberculosis medicines is crucial to improve tuberculosis control at times of emerging Mycobacterium tuberculosis drug resistance. Methods: We investigated access to genotypic and phenotypic M tuberculosis drug susceptibility testing (DST), availability of anti-tuberculosis drugs and calculated cost of drugs and treatment regimens at major tuberculosis treatment centers in countries of the World Health Organization (WHO) European region. Results are stratified by middle and high- income countries. Results: Overall, 43 treatment centers in 43 countries participated in the study. Phenotypic DST was available for WHO group A drugs levofloxacin/moxifloxacin, bedaquiline and linezolid, in 75%/82%, 48%, and 72% of countries, respectively. Overall, 84% and 56% of countries had access to bedaquiline and delamanid, while only 14% had access to rifapentine. Median cost (in Euros) of regimens for drug-susceptible tuberculosis, multidrug-resistant tuberculosis (shorter regimen, including bedaquiline for six months) and pre-extensively drug-resistant tuberculosis (including delamanid) were 44, 764 and 7 094 in middle income countries (n=12), and 280, 29 765, 207 035 in high income countries (n=29). Conclusion: Tuberculosis control in Europe is limited by widespread lack of DST capacity to new and re-purposed drugs, lack of access to essential medications and high treatment cost for drug-resistant tuberculosis.

Rifapentine access in Europe: growing concerns over key tuberculosis treatment component

“…Within the Tuberculosis Network European Trials group (TBnet), a tuberculosis-oriented network of clinicians and scientists [ 8 ], a survey was performed in June–December 2020 and updated in October 2021 to investigate access to anti-tuberculosis drugs in the WHO Europe region. Out of 53 countries in the region, TBnet collaborating clinicians were contacted in 46 countries, and 43 replied: overall, rifapentine was available only in two middle-income and four high-income countries (14% of the total) [ 9 ]. Regrettably, these results are not surprising.…”