Division of Clinical Infectious Diseases, German Center for Infection Research (DZIF) Clinical Tuberculosis Unit, Research Center, Borstel, Germany Department of Medicine, University of Namibia School of Medicine, Windhoek, Namibia Both authors contributed equally to the manuscript.
Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK Both authors contributed equally to the manuscript.
Eur Respir J. 2015 Apr;45(4):1081-8. doi: 10.1183/09031936.00124614. Epub 2014 Nov 13.
Data on availability and cost of anti-tuberculosis (TB) drugs in relation to affordability at national level are scarce. We performed a cross-sectional study on availability and cost of anti-TB drugs at major TB-reference centres in 37 European countries. Costs of standardised treatment regimens used for pan-sensitive TB, multidrug-resistant (MDR) TB, pre-extensively drug-resistant (XDR) TB, and XDR-TB were compared using a purchasing power analysis. Affordability was evaluated in relation to monthly national gross domestic products per capita (GDP). At least one second-line injectable and either moxifloxacin or levofloxacin were available in all countries. Linezolid and clofazimine were available in 79% and 46% of the countries, respectively. Drug cost for XDR-TB was three-times more expensive than those for MDR-TB. The average price of treatment for pan-sensitive TB represented a maximum of 8.5% of the monthly GDP across countries, while for standard MDR-TB treatment this was <30% in only six countries and more than 100% in four countries. Treatment of XDR-TB represented more than 100% of a month's GDP in all countries where the regimen was available. High cost and limited availability of drugs for treatment of drug-resistant TB, particularly beyond resistance to first-line drugs, are a major impediment to successful TB control in Europe.
关于国家层面负担能力与抗结核（TB）药物可得性和费用的相关数据非常有限。我们针对 37 个欧洲国家的主要结核病参考中心进行了一项横断面研究，以了解抗 TB 药物的可得性和费用。使用购买力平价分析比较了用于泛耐药性结核病、耐多药结核病（MDR-TB）、广泛耐药结核病（XDR-TB）和耐多药广泛耐药结核病（XDR-TB）的标准化治疗方案的成本。根据每月人均国民生产总值（GDP）评估负担能力。所有国家都至少有一个二线注射剂和莫西沙星或左氧氟沙星。利奈唑胺和氯法齐明在 79%和 46%的国家中可用。XDR-TB 的药物费用比 MDR-TB 贵三倍。各国泛耐药性结核病治疗的平均价格最高占每月 GDP 的 8.5%，而标准 MDR-TB 治疗的费用在仅 6 个国家中低于 30%，在 4 个国家中超过 100%。在有治疗方案的所有国家中，XDR-TB 的治疗费用都超过了一个月 GDP 的 100%。治疗耐药性结核病的药物费用高且供应有限，尤其是在一线药物耐药性之后，这是欧洲结核病控制成功的主要障碍。
