PMID- 21573227
OWN - NLM
STAT- MEDLINE
DCOM- 20111024
LR  - 20211020
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 6
IP  - 5
DP  - 2011 May 4
TI  - Size and usage patterns of private TB drug markets in the high burden countries.
PG  - e18964
LID - 10.1371/journal.pone.0018964 [doi]
LID - e18964
AB  - 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.
FAU - Wells, William A
AU  - Wells WA
AD  - Global Alliance for TB Drug Development, New York, New York, United States of 
      America. william.wells@tballiance.org
FAU - Ge, Colin Fan
AU  - Ge CF
FAU - Patel, Nitin
AU  - Patel N
FAU - Oh, Teresa
AU  - Oh T
FAU - Gardiner, Elizabeth
AU  - Gardiner E
FAU - Kimerling, Michael E
AU  - Kimerling ME
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20110504
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Antitubercular Agents)
SB  - IM
MH  - Antitubercular Agents/*economics/*therapeutic use
MH  - Humans
MH  - India
MH  - Indonesia
MH  - Pakistan
MH  - Private Sector/*economics
MH  - Public Sector/economics
MH  - Tuberculosis/*drug therapy/*economics
PMC - PMC3087727
COIS- Competing Interests: CFG, TO and NP are employed by IMS Health, Inc., which is a 
      for-profit company that markets the databases used as primary data sources in 
      this study. This does not alter the adherence by all authors to all the PLoS ONE 
      policies on sharing data and materials.
EDAT- 2011/05/17 06:00
MHDA- 2011/10/25 06:00
PMCR- 2011/05/04
CRDT- 2011/05/17 06:00
PHST- 2010/12/07 00:00 [received]
PHST- 2011/03/14 00:00 [accepted]
PHST- 2011/05/17 06:00 [entrez]
PHST- 2011/05/17 06:00 [pubmed]
PHST- 2011/10/25 06:00 [medline]
PHST- 2011/05/04 00:00 [pmc-release]
AID - PONE-D-10-06518 [pii]
AID - 10.1371/journal.pone.0018964 [doi]
PST - epublish
SO  - PLoS One. 2011 May 4;6(5):e18964. doi: 10.1371/journal.pone.0018964.