TB cocktail beyond activists’ cost limit

A newly approved three-drug treatment for tuberculosis (TB) will be available in 150 countries including India and SA, priced at $1,040 for a complete regimen, more than twice the cost proposed in the past by advocacy groups for other treatments.

A newly approved three-drug treatment for tuberculosis (TB) will be available in 150 countries, including India and SA, priced at $1,040 for a complete regimen, more than twice the cost proposed in the past by advocacy groups for other treatments.

The World Health Organisation (WHO)-backed Stop TB Partnership said on Monday BPaL will be obtainable in eligible countries through the Global Drug Facility (GDF), a global provider of TB medicines created in 2001 to negotiate lower prices for treatments.

In 2018, TB led to 1.5-million deaths.

BPaL is an oral treatment that promises a shorter, more convenient option compared to existing TB treatments, which use a cocktail of antibiotic drugs over a period of up to two years.

The new cocktail, which will treat extensively drug-resistant strains of the illness, consists of drug developer TB Alliance’s newly approved medicine pretomanid, in combination with linezolid and Johnson & Johnson’s bedaquiline.

Pretomanid, which will be available at $364 per course, is only the third new medicine for drug-resistant TB approved in about 40 years, after Johnson & Johnson’s bedaquiline and Otsuka Pharmaceutical’s delamanid.

Advocacy groups have long criticised the cost of bedaquiline and delamanid. Nonprofit Médecins Sans Frontières (MSF) has waged a running battle in public with Johnson & Johnson’s over its $400 price tag for a sixmonth course of bedaquiline.

MSF argues that bedaquiline could be produced and sold at a profit for 25c a day, and that the price of treatments for drugresistant TB should be no higher than $500 for a full course.

But Stop TB Partnership says costs of other regimens for extremely drug-resistant TB range from $2,000 to $8,000 for courses of at least 20 months.

TB Alliance in April granted a licence to US drugmaker Mylan NV to make and sell pretomanid as part of certain regimens in high-income markets, as well as a nonexclusive licence for lowincome and middle-income countries, where most tuberculosis cases occur.

Stop TB Partnership said it will start supplying the regimen following WHO guidance on using the drug. Mylan, however, said it will also sell the drug directly to countries.

Prices in low-income countries will be in line with the price offered through GDF, but will be decided on a case-by-case basis where the drug is not supplied through GDF, it said.

The drug will be available in bottles of 26 tablets, with a six-month treatment requiring seven bottles.