Size and Usage Patterns of Private TB Drug Markets in the High Burden Countries
Size and Usage Patterns of Private TB Drug Markets in the High Burden Countries
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DOI：
10.1371/journal.pone.0018964
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发表时间：
2011-05-04
期刊：
影响因子：
3.7
通讯作者：
Kimerling, Michael E.
中科院分区：
文献类型：
--
作者：
Wells, William A.;Ge, Colin Fan;Kimerling, Michael E.
背景：结核病的控制主要被认为是一个公共卫生问题，私营部门的结核病治疗引起的关注较少。因此，私营部门结核病药物销售的规模和特征在很大程度上仍然未知。方法/主要发现：我们使用IMS健康数据分析了10个高负担国家(HBC)的私人结核病药物消费，首先绘制了IMS数据覆盖范围与私人市场重叠的程度。我们将私人市场定义为任何不受国家结核病计划使用或影响的渠道。四个国家的私人市场--巴基斯坦、菲律宾、印度尼西亚和印度--的相对销售量最大；每年，他们销售的一线结核病药物足以提供各自国家估计的年度病例的65%-117%，标准的6-8个月方案。5个国家的一线药物数量主要是固定剂量组合(FDC)，但其他5个国家的药物数量主要是松散药物。在10个国家中，这些药物有37种(散装药物)加74种不同强度的FDDC。有54家不同的、重要的一线制造商(每个国家有2-11家)，大多数公司只在一个研究国家销售结核病药物。然而，FDC市场更为集中，有4家公司占据了这10个国家69%的FDC交易量。在二线药物中，氟喹诺酮类药物广泛可用，在印度、巴基斯坦和印度尼西亚用于治疗结核病的药物数量很大。然而，世界卫生组织推荐的某些药物没有供应，总体上没有足够的药量来覆盖耐多药结核病(MDR-TB)的大部分预期负担。结论/意义：几个HBC的私人结核病药物市场庞大、稳定和复杂。这需要适当的政策和市场反应，包括扩大公私混合(PPM)计划，扩大公共计划的覆盖面、灵活性和吸引力，加强监管和质量执行，以及扩大公共耐多药结核病治疗计划。
Background: Tuberculosis (TB) control is considered primarily a public health concern, and private sector TB treatment has attracted less attention. Thus, the size and characteristics of private sector TB drug sales remain largely unknown.Methodology/Principal Findings: We used IMS Health data to analyze private TB drug consumption in 10 high burden countries (HBCs), after first mapping how well IMS data coverage overlapped with private markets. We defined private markets as any channels not used or influenced by national TB programs. Private markets in four countries - Pakistan, the Philippines, Indonesia and India - had the largest relative sales volumes; annually, they sold enough first line TB drugs to provide 65-117% of the respective countries' estimated annual incident cases with a standard 6-8 month regimen. First line drug volumes in five countries were predominantly fixed dose combinations (FDCs), but predominantly loose drugs in the other five. Across 10 countries, these drugs were available in 37 (loose drug) plus 74 (FDCs) distinct strengths. There were 54 distinct, significant first line manufacturers (range 2-11 per country), and most companies sold TB drugs in only a single study country. FDC markets were, however, more concentrated, with 4 companies capturing 69% of FDC volume across the ten countries. Among second line drugs, fluoroquinolones were widely available, with significant volumes used for TB in India, Pakistan and Indonesia. However, certain WHO-recommended drugs were not available and in general there were insufficient drug volumes to cover the majority of the expected burden of multidrug-resistant TB (MDR-TB).Conclusions/Significance: Private TB drug markets in several HBCs are substantial, stable, and complicated. This calls for appropriate policy and market responses, including expansion of Public-Private Mix (PPM) programs, greater reach, flexibility and appeal of public programs, regulatory and quality enforcement, and expansion of public MDR-TB treatment programs.