Laing R O, McGoldrick K M
Department of International Health, Boston University School of Public Health, Massachusetts 02118, USA.
Int J Tuberc Lung Dis. 2000 Dec;4(12 Suppl 2):S194-207.
Access to tuberculosis drugs depends on multiple factors. Selection of a standard list of TB drugs to procure is the first step. This paper reviews the advantages and disadvantages of procuring and using fixed-dose combination (FDC) products for both the intensive and continuation phases of treatment. The major advantages are to prevent the emergence of resistance, to simplify logistic management and to reduce costs. The major disadvantage is the need for the manufacturers to assure the quality of these FDCs by bioavailability testing. The paper reports on the inclusion of second-line TB drugs in the 1999 WHO Essential Drug List (EDL). The need to ensure that these drugs are used within established DOTS-Plus programs is stressed. The price of TB drugs is determined by many factors, including producer prices, local taxes and duties as well as mark-ups and fees. TB drug prices for both the public and private sectors from industrialized and developing countries are reported. Price trends over time are also reported. The key findings of this study are that TB drug prices have generally declined in developing countries while they have increased in developed countries, both for the public and private sectors. Prices vary between countries, with the US paying as much as 95 times the price paid in a specific developing country. The prices of public sector first-line TB drugs vary little between countries, although differences do exist due to the procurement methods used. The price of tuberculin, a diagnostic agent, has increased dramatically in the US, with substantial inter-country variations in price. The paper suggests that further research is necessary to identify the reasons for the price disparities and changes over time, and suggests methods which can be used by National Tuberculosis Programme managers to ensure availability of quality assured TB drugs at low prices.
获得抗结核药物取决于多种因素。选择采购的标准抗结核药物清单是第一步。本文回顾了在治疗的强化期和持续期采购和使用固定剂量复方制剂（FDC）产品的优缺点。主要优点是防止耐药性的出现、简化物流管理并降低成本。主要缺点是制造商需要通过生物利用度测试来确保这些FDC的质量。本文报告了1999年世界卫生组织基本药物清单（EDL）中纳入二线抗结核药物的情况。强调了确保在既定的强化治疗方案中使用这些药物的必要性。抗结核药物的价格由许多因素决定，包括生产商价格、地方税费以及加价和费用。报告了工业化国家和发展中国家公共部门和私营部门的抗结核药物价格。还报告了随时间的价格趋势。本研究的主要发现是，发展中国家的抗结核药物价格总体上有所下降，而发达国家的价格则有所上涨，公共部门和私营部门都是如此。各国之间价格存在差异，美国支付的价格高达某个特定发展中国家支付价格的95倍。公共部门一线抗结核药物的价格在各国之间差异不大，尽管由于采购方式的不同确实存在差异。诊断试剂结核菌素的价格在美国大幅上涨，各国之间价格差异很大。本文建议有必要进行进一步研究以确定价格差异和随时间变化的原因，并建议国家结核病规划管理人员可采用的方法，以确保以低价提供质量有保证的抗结核药物。
