Global Tuberculosis Report -- 2012.pdf

BOX 5.1Fun ding for diagnosis and treatment of MDR-TB, 2009–2013The geographical distribution of MDR-TB cases differs considerably from that of all TB cases. Of the estimated 310 000 MDR-TB cases amongnotifi ed pulmonary TB cases in 2011, almost 60% were accounted for by three countries: (in rank order) India, China and the Russian Federation(Chapter 4). Of the 27 high MDR-TB burden countries that account for about 85% of estimated cases globally, 15 are in the European Region,where the prevalence of MDR-TB among new and previously treated cases is highest (ranging from 9%–32% in new cases and 29%–76%among previously treated cases). The costs of diagnosing and treating MDR-TB are also much higher than the costs of diagnosing and treatingdrug-susceptible TB. The regimens recommended in WHO guidelines, which last 20 months for most patients, can cost several thousands of USdollars. Other costs associated with patient care are also high. 1The funding available for MDR-TB treatment in the 104 countries that reported fi nancial data, and which have 75% of the world’s estimatedcases of MDR-TB, increased from US$ 0.5 billion in 2009 to US$ 0.6 billion in 2011 (Table B5.1.1). 1 This fi gure is expected to increase to morethan US$ 0.7 billion in 2012 and 2013. NTP spending on second-line drugs and programme management accounts for about three quarters ofthe total. Second-line drugs alone now amount to more than US$ 0.3 billion per year. The remaining funding (about US$ 0.2 billion) is channelledthrough general health-care services (GHS) for inpatient and outpatient treatment of patients with MDR-TB.TABLE B5.1.1Funding available and reported gaps for MDR-TB in 104 low- and middle-income countries, US$ millions2009 2010 2011 2012 2013Low- and middle-income Available funding a 450 566 615 719 705countriesAvaliable (NTP only) b 353 445 443 541 523Avaliable (GHS only) 97 121 172 178 183% domestic c 89 90 85 71 78Reported gap 117 58 81 115 84High MDR-TB burden Available funding a 384 490 526 610 600countriesAvaliable (NTP only) b 315 409 408 492 472Avaliable (GHS only) 68 81 118 119 128% domestic c 90 91 85 70 77Reported gap 109 42 58 94 61Upper middle-income Available funding a 387 501 513 533 521countriesAvaliable (NTP only) b 307 400 373 389 374Avaliable (GHS only) 80 101 140 144 148% domestic c 95 97 93 86 92Reported gap 99 6 11 67 8Lower middle-income Available funding a 48 54 82 158 162countriesAvaliable (NTP only) b 33 35 53 128 131Avaliable (GHS only) 15 19 28 30 31% domestic c 57 42 46 32 40Reported gap 11 38 49 26 42Low-income countries Available funding a 14 11 20 28 21Avaliable (NTP only) b 13 9 16 24 18Avaliable (GHS only) 1 2 3 4 3% domestic c 38 29 34 26 31Reported gap 6 15 22 23 33GHS, general health-care services for hospital stays and clinic visits; MDR-TB, multidrug-resistant TB; NTP, national TB control programme or equivalentaIncludes funding for second-line drugs, MDR-TB programme management and supervision and estimated cost of GHS for patients with MDR-TB.bIncludes funding for second-line drugs, MDR-TB programme management and supervision only.cAssumes GHS is domestically funded.About 85% of the funding available is concentrated in the high MDR-TB burden countries, in particular upper middle-income countries. Inabsolute terms, China and India have the largest external grants for MDR-TB, at US$ 41 million and US$ 43 million respectively from the GlobalFund in 2013. Meanwhile, low-income and lower middle-income countries report a funding gap of US$ 75 million in 2013, leaving almost onethird of their budgets for MDR-TB unfunded.1Fitzpatrick C, Floyd K. A systematic review of the cost and cost effectiveness of treatment for multidrug-resistant tuberculosis. Pharmacoeconomics, 2012,30:63–80.56 WHO REPORT 2012 GLOBAL TUBERCULOSIS CONTROL