Barriers and Strategies: A Review of Access to Affordable Multi-Drug Resistant Tuberculosis Medication in China

Abstract

Yuou Zhang,1 Xuan Liu,1 Linghe Yang,1 Guifang Zhang,2 Zhaoru Gu,3 Zhongdan Chen,4 Jing Sun1 1School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China; 2Institute of Geriatrics, Beijing Hospital, Beijing, People’s Republic of China; 3Institute of Cancer, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 4Hepatitis/TB/HIV/STI, World Health Organization, Office of the WHO Representative in China, Beijing, People’s Republic of ChinaCorrespondence: Jing Sun Email [email protected]: This study analyzed the barriers of patient access to affordable MDR-TB medication in China and the reasons behind, and proposed strategies towards removing the barriers based on literature review and key informant interviews. Reasons behind the high financial burden of MDR-TB patients in China are the lack of a coordinated and multi-sourced financing model to secure patients’ access to the expensive novel medicines, and the absence of the safety-net for the patients with low ability to pay the costs. Appropriate health insurance benefit packages and provider payment mechanisms, supportive legal framework, coordinated policies as well as incentives for off-label use of evidence-based repurposed medicines are missing. The observations identified key intervention areas including continued efforts to make the novel effective medicines affordable and to strengthen the legislative protection for off-label use of evidence-based medicines; increase incentives for pharmaceutical companies to expand indications of established medicines based on the evidence; implement public initiatives to support the use of repurposed medicines for diseases with major public health significance, and scale up good practices from local pilots to create a coordinated multi-sourced financing model. A comprehensive approach to address the barriers in the full treatment course of MDR-TB and a safety-net for low-ability-to-pay patients are also critical to secure universal access to affordable MDR-TB medication.Keywords: MDR-TB, medication, affordable, financing, safety-net, off-label use, repurposed medicines

Keywords

• mdr-tb
• medication
• affordable
• financing
• safety-net
• off-label use
• repurposed medicines