Pharmaceutical cost dynamics for the treatment of rifampicin-resistant tuberculosis in children and adolescents in South Africa, India, and the Philippines

被引:0
|
作者
Wilkinson, Thomas [1 ]
Garcia-Prats, Anthony J. [2 ,3 ]
Sachs, Tina [3 ]
Paradkar, Mandar [4 ,5 ]
Suryavanshi, Nishi [4 ,5 ]
Kinikar, Aarti [6 ]
Frias, Melchor V. [7 ]
Sinanovic, Edina [1 ]
Hesseling, Anneke C. [3 ]
Seddon, James. A. [3 ,8 ]
Palmer, Megan [3 ]
机构
[1] Univ Cape Town, Sch Publ Hlth & Family Med, Hlth Econ Unit, Cape Town, South Africa
[2] Univ Wisconsin Madison, Sch Med & Publ Hlth, Dept Pediat, Madison, WI USA
[3] Stellenbosch Univ, Fac Med & Hlth Sci, Desmond Tutu TB Ctr, Dept Paediat & Child Hlth, Stellenbosch, South Africa
[4] Johns Hopkins Univ Clin Res Site, Byramjee Jeejeebhoy Govt Med Coll, Pune, Maharashtra, India
[5] Johns Hopkins India, Ctr Infect Dis India, Pune, India
[6] Byramjee Jeejeebhoy Govt Med Coll Sassoon Gen Hos, Dept Paediat, Pune, Maharashtra, India
[7] De La Salle Med & Hlth Sci Inst, Res Div, Dasmarinas City, Cavite, Philippines
[8] Imperial Coll London, Dept Infect Dis, London, England
来源
PLOS ONE | 2024年 / 19卷 / 07期
关键词
REGIMENS; DISEASE;
D O I
10.1371/journal.pone.0305930
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Rifampicin-resistant (RR) tuberculosis (TB) in children is a major global health concern but is often neglected in economics research. Accurate cost estimations across the spectrum of paediatric RR-TB treatment regimens are critical inputs for prioritisation and budgeting decisions, and an existing knowledge gap at local and international levels. This normative cost analysis was nested in a Phase I/II pharmacokinetics, safety, tolerability, and acceptability trial of TB medications in children in South Africa, the Philippines and India. It assessed the pharmaceutical costs of 36 childhood RR-TB regimens using combinations from 16 different medicines in 34 oral formulations (adult and child-friendly) in 11 weight bands in children <15 years of age. The analysis used local and Global Drug Facility pricing, and local and international guideline recommendations, including adaptions of BPaL and BPaLM regimens in adults. Costs varied significantly between regimen length, age/weight banding, severity of disease, presence of fluroquinolone resistance, and different country guideline recommendations. WHO recommended regimen costs ranged 12-fold: from US$232 per course (short regimen in non-severe disease) to US$2,761 (long regimen in severe, fluroquinolone-resistant disease). Regimen treating fluoroquinolone-resistant infection cost US$1,090 more than comparable WHO-recommended regimen. Providing child-friendly medicine formulations in <5-year-olds across all WHO-recommended regimens is expected to cost an additional $380 (range $212-$563) per child but is expected to have wider benefits including palatability, acceptability, adherence, tolerability, and dose accuracy. There were substantial differences in regimen affordability between countries when adjusted for purchasing power and domestic spending on health. Appropriate, effective, and affordable treatment options are an important component of the fight against childhood RR-TB. A comprehensive understanding of the cost and affordability dynamics of treatment options will enable national TB programs and global collaborations to make the best use of limited healthcare resources for the care of children with RR-TB.
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页数:16
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