Pathway to Patients: Lessons from Today's Market for Tomorrow's TB Drugs

* This post is co-authored by Jessica PickettThe TB Alliance has just released an analysis of the global market for TB drugs, finding that approximately $315 million is spent on first-line treatment worldwide each year; in-depth studies of 10 focus countries (Brazil, China, France, India, Indonesia, Japan, the Philippines, South Africa, the UK and the US) revealed that an additional $54 million is spent annually on expensive second-line treatments in those countries alone. The study, aptly titled Pathway to Patients, highlights the significant - but often overlooked - impact of private sector distribution channels and funding streams on the effectiveness of national TB programs, and the high degree of variability in supply chains by country. The market is further fragmented between more than four first-line drugs that are each produced by a multiplicity of suppliers, with domestic drug production facilities playing a key role. Taken as a whole, the findings implicitly underscore the need for public-private partnerships to facilitate the development of new products where industry alone lacks the necessary commercial incentives.Importantly, this report goes beyond painting a picture of today's supply chain to begin mapping out the factors that will affect the introduction and uptake of new TB drug regimens in the coming years. New diagnostics will increase case findings, and hopefully demand for treatment; conversely, the development of a more effective preventative vaccine would reduce the number of infected patients. Policies that shift patients from the private to public sector for treatment may decrease the value of the private market while increasing public tenders. At the global level, new fundings schemes like the Global Fund and UNITAID are increasing access to second-line TB medications (which is good), but the resulting dependence on external donors - in stark contrast to the current predominance of domestic sources - could render TB programs susceptible to notoriously volatile aid flows (which is, uh, bad). And of course the profile of the new drugs themselves will influence the market dynamics: shortened treatment will help increase patient adherence, decrease default rates, curtail costs, and improve health outcomes - all of which are expected to increase product demand.With this in mind, the authors endorse the creation of global health infomediary to improve demand forecasting and help contribute to a shared understanding of market dynamics, treatment benefits, manufacturing and supply chain issues, operational changes, donor policies, price elasticity of demand and other attributes that will influence decisions to develop, adopt and use new TB treatment regimens. With so many new products coming down the pipeline - not just for TB, but for AIDS, malaria, and other developing country diseases, too - the challenges of product introduction are rapidly becoming urgent and widespread: kudos to the TB Alliance for facing them head on, early on.Update, 6/27/07: First The Lancet and now The Lancet Infectious Diseases (free registration required) have highlighted the TB Alliance study and its support for the global health infomediary in particular.