The contribution of drug import to the cost of tuberculosis treatment: A cost analysis of longer, shorter, and short drug regimens for Karakalpakstan, Uzbekistan

Abstract

Tuberculosis (TB) programs depend on a continuous supply of large amounts of high-quality TB drugs. When TB programs procure TB drugs from international suppliers, such as the Global Drug Facility, they can incur import costs for international transport, customs clearance, and national transport. We assessed the drug costs and import costs of 18 longer (≥18 months), 10 shorter (9–12 months), and 8 short (≤6 months) drug regimens for drug-sensitive (DS) and multidrug-resistant (MDR)-TB treatment. Costs per regimen were estimated by multiplying recommended drug amounts with 2021 Global Drug Facility prices and drug import costs of a TB program in Karakalpakstan, Uzbekistan. The standard short-course treatment of DS-TB requires taking 730 fixed-dose combination tablets, which weigh 0.79 kg and cause an import cost of $4.19 (9.8% of the regimen’s drug cost of $43). A new 4-month DS-TB regimen requires taking 1358 tablets, which weigh 1.1 kg and cause an import cost of $6.07 (2.6% of the regimen’s drug cost of $233). MDR-TB regimens that last between 24 weeks and 20 months involve 546–9368 tablets and injections. The drugs for these MDR-TB regimens were estimated to weigh 0.42–96 kg and cause an import cost of $2.26–507 per drug regimen (0.29–11% of a regimen’s drug cost of $360–15,028). In a multivariable regression analysis, an additional treatment month increased the import cost of a drug regimen by $5.45 (95% CI: 1.65 to 9.26). Use of an injectable antibiotic in a regimen increased the import cost by $133 (95% CI: 47 to 219). The variable and potentially sizable import costs of TB regimens can affect the financial needs of TB programs. Drug regimens that are shorter and all-oral tend to reduce import costs compared to longer regimens and regimens including an injectable drug.

Trends in the availability and prices of quality-assured tuberculosis drugs: a systematic analysis of Global Drug Facility Product Catalogs from 2001 to 2024

“…The price of the dose equivalent of 672 FDC tablets RH in a 150 mg/75 mg ratio used during the continuation phase increased from $7.19 in 2002 to $31.78 since the end of 2022. Although drug-susceptible TB drug regimen cost less than drug-resistant TB drug regimens [ 15 ], increasing prices for drugs used in drug-susceptible TB treatment could increase funding needs in TB care as drug-susceptible TB is more common than drug-resistant TB. The estimated 2022 global incidence of drug-resistant TB was 5.2 (95% uncertainty interval: 4.7 to 5.7) per 100,000 as compared to a total TB incidence of 133 (95% uncertainty interval: 124 to 143) per 100,000 [ 40 ].…”

“…The price of 100 tablets moxifloxacin (Mfx) 400 mg decreased from $168 in 2011, to $64.51 in 2014, to a price between $15 and $16.90 since 2019. Considering the large cost contributions of pretomanid and bedaquiline to the price of BPaL and BPaLM regimens [15,20], falling prices for these drugs contribute to substantial cost savings in TB treatment with BPaL and BPaLM regimens.…”

“…GDF products and prices are relevant for numerous national TB programs and are used in cost and costeffectiveness analyses of TB care [15][16][17][18][19][20][21]. Despite the common use of GDF prices as reference prices, past GDF Product Catalogs, GDF products, or GDF prices have been neither comprehensively assembled nor systematically analyzed in the existing literature.…”

A Framework for Assessing Import Costs of Medical Supplies and Results for a Tuberculosis Program in Karakalpakstan, Uzbekistan

“…Using the presented framework and results, we estimated in another study that one course of TB treatment can require the import of 0.6 kg to 36 kg of drugs, drug packaging, and cargo packaging. Importing this weight to the TB program in Karakalpakstan could add between $3.16 and $185 to the purchasing cost of one drug regimen with import costs updated to 2020/21 prices and converted to US dollar [ 54 ] Unveiling medical supplies to which relatively high import costs are allocated. While cost allocation relies on assumptions, its results can be a sound starting point for further investigation Optimizing the packaging of imports to reduce waste and import costs (compare [ 16 , 55 ]).…”

“…Using the presented framework and results, we estimated in another study that one course of TB treatment can require the import of 0.6 kg to 36 kg of drugs, drug packaging, and cargo packaging. Importing this weight to the TB program in Karakalpakstan could add between $3.16 and $185 to the purchasing cost of one drug regimen with import costs updated to 2020/21 prices and converted to US dollar [ 54 ]…”