<p>Barriers and Strategies: A Review of Access to Affordable Multi-Drug Resistant Tuberculosis Medication in China</p>

Abstract

This study analyzed the barriers of patient access to affordable MDR-TB medication in China and the reasons behind, and proposed strategies towards removing the barriers based on literature review and key informant interviews. Reasons behind the high financial burden of MDR-TB patients in China are the lack of a coordinated and multi-sourced financing model to secure patients' access to the expensive novel medicines, and the absence of the safety-net for the patients with low ability to pay the costs. Appropriate health insurance benefit packages and provider payment mechanisms, supportive legal framework, coordinated policies as well as incentives for off-label use of evidence-based repurposed medicines are missing. The observations identified key intervention areas including continued efforts to make the novel effective medicines affordable and to strengthen the legislative protection for off-label use of evidence-based medicines; increase incentives for pharmaceutical companies to expand indications of established medicines based on the evidence; implement public initiatives to support the use of repurposed medicines for diseases with major public health significance, and scale up good practices from local pilots to create a coordinated multi-sourced financing model. A comprehensive approach to address the barriers in the full treatment course of MDR-TB and a safety-net for low-ability-to-pay patients are also critical to secure universal access to affordable MDR-TB medication.

Impacts of a Comprehensive TB Control Model on the Quality of Clinical Services and the Financial Burden of Treatment for Patients with Drug-resistant Tuberculosis in China: A Mixed-methods Evaluation

“…In addition to nancing policies, cost control is also crucial for reducing the nancial burden and developing feasible nancial support policies for DRTB patients. On the one hand, the unit-price of some tests and medicines are expensive, as evidenced in previous studies and our qualitative research [13]. The health insurance o ce may take the lead in the negotiation to lower the price for the necessary tests and medicines, as suggested before for the promotion of GeneXpert.…”

“…However, the nancial protection provided by the three types of public health insurance in China, [the urban employee basic medical insurance (UEBMI), urban resident basic medical insurance (URBMI), and new rural cooperative medical schemes (NCMS)], is often insu cient to cover the costs. One major reason is that many medical services, such as some second-line anti-TB drugs, are only partially covered by insurance or may need to be paid fully out-of-pocket [9][10][11][12][13]. Additionally, under China's current TB control model, DRTB patients are treated in the prefecture-level designated hospital.…”

Impacts of a comprehensive tuberculosis control model on the quality of clinical services and the financial burden of treatment for patients with drug-resistant tuberculosis in China: a mixed-methods evaluation

“…In addition to financing policies, cost containment is also crucial for reducing the financial burden and developing feasible financial support policies for DRTB patients. On the one hand, the unit-price of some tests and medicines are expensive, as evidenced in previous studies and our qualitative research [ 12 ]. The health insurance office may take the lead in the negotiation to lower the price for the necessary tests and medicines, as suggested before for the promotion of GeneXpert.…”

“…In China the financial protection provided by the three types of public health insurance in China, [the Urban Employee Basic Medical Insurance (UEBMI), Urban Resident Basic Medical Insurance (URBMI), and new rural cooperative medical schemes (NCMS)], is often insufficient to cover the costs. One major reason is that many medical services, such as some second-line anti-TB drugs, are only partially covered by insurance or may need to be paid fully out-of-pocket [ 9 – 12 ]. Additionally, under China’s current TB control model, DRTB patients are treated in the prefecture-level designated hospital, typically a third-level hospital with relative low reimbursement rates under the public health insurance system.…”

Prevalence of Multidrug-Resistant Tuberculosis in Dalian, China: A Retrospective Study

“…Screening, treatment, and hospitalization were provided free of charge for TB patients to improve their adherence and willingness to participate in anti-TB treatment. 26 , 27 As a result, the total treatment success rate for MDR-TB was up to 62.6% from 2012 to 2019 ( Figure 1 ).

Figure 1 Strategies for the prevention and control of MDR-TB in Dalian.

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