SA's fight against drug-resistant tuberculosis (DR-TB) and a plan to introduce a shorter, simpler treatment regimen has received a boost — a significant price reduction for a potent antibiotic.
As the country is about to amend national guidelines for DR-TB to provide a six-month regimen (which includes bedaquiline, pretomanid linezolid and moxifloxacin — BPaLM) as a new standard of care in January, US-drug maker Viatris, not-for-profit drug developer TB Alliance, also based in the US, and the UK’s MedAccess announced pretomanid’s price would drop by 34%
In an agreement this week, the trio said the reduction will allow more TB patients to receive the newer treatment regimen, which remains expensive worldwide.
Viatris, TB Alliance and MedAccess said the agreement will “help to expand access to critical new treatment in more than 140 countries, including those with the highest TB burden”.
SA is one of eight countries with such a burden — 3.6% of TB infections occur here. India has the most cases at 26%, while the number in China is 8.5%.
Under the agreement, MedAccess, a social finance company, will provide volume guarantee to Viatris, which will reduce the ceiling price of pretomanid to $240 (about R4,100) for six months. This will help to bring BPaL (which includes bedaquiline, pretomanid and linezolid) and BPaLM substantially closer to $500 (about R8,600) per patient course.
Dr Norbert Ndjeka, director of the health department’s TB programme, said while it is not known when the discounted price will apply, once implemented it will benefit South Africa as the savings translate to more patients receiving treatment.
Ndjeka said though this country should by now have amended its DR-TB guidelines to include the six-month regimen, it had to withhold implementation to await the reduction.
“We’re hoping to start it in January ... there is no clarity yet from the suppliers, but we should hear from Viatris soon as they are commercialising this product.”
When South Africa implements the regimen, it is expected to be the world’s first in improving DR-TB treatment and care, having a few years ago removed painful and toxic injectables with side effects such as hearing loss.
MedAccess projects that its guarantee will enable an additional 36,000 patients to be treated successfully and help avert 31,000 adverse events that require hospitalisation or cause disability as patients switch from the current standard of care.
The six-month, all-oral regimen has been found to cure 89% to 91% of multidrug-resistant TB (MDR-TB) patients.
Globally, less than two-thirds of DR-TB patients are successfully treated. Previously recommended treatments have been limited, expensive, toxic and lengthy, requiring patients to take more than 20 pills a day for nine to 20 months. With new World Health Organisation (WHO) guidance on TB treatment, almost all DR-TB patients will be eligible for the shorter BPaL/BPaLM regimens.
In November, before the price discount, a study found the BPaLM/BPaL treatment regimen could save governments up to $740m (about R12,7bn) annually. That is enough to fund DR-TB treatments for more than 400,000 people.
Blessi Kumar, CEO of Global Coalition of TB Activists, welcomed the reduction. “Coming on the heels of the WHO consolidated guidelines for DR-TB treatment, we hope this will be the game changer in ensuring access for people with DR-TB and reaching better treatment outcomes.
“The challenge, however, continues to be the uptake at country level, and we urge national treatment programmes to make this shorter regimen available to people with DR-TB at the earliest. Ensuring early and easy access is key to a people-centred, rights-based TB response.”
Would you like to comment on this article?
Sign up (it's quick and free) or sign in now.
Please read our Comment Policy before commenting.