Tuberculosis (TB) programs depend on a continuous supply of large amounts of high-quality TB drugs. When TB programs procure TB drugs from international suppliers, such as the Global Drug Facility, they can incur import costs for international transport, customs clearance, and national transport. We assessed the drug costs and import costs of 18 longer (≥18 months), 10 shorter (9-12 months), and 8 short (≤6 months) drug regimens for drug-sensitive (DS) and multidrug-resistant (MDR)-TB treatment. Costs per regimen were estimated by multiplying recommended drug amounts with 2021 Global Drug Facility prices and drug import costs of a TB program in Karakalpakstan, Uzbekistan. The standard short-course treatment of DS-TB requires taking 730 fixed-dose combination tablets, which weigh 0.79 kg and cause an import cost of $4.19 (9.8% of the regimen's drug cost of $43). A new 4-month DS-TB regimen requires taking 1358 tablets, which weigh 1.1 kg and cause an import cost of $6.07 (2.6% of the regimen's drug cost of $233). MDR-TB regimens that last between 24 weeks and 20 months involve 546-9368 tablets and injections. The drugs for these MDR-TB regimens were estimated to weigh 0.42-96 kg and cause an import cost of $2.26-507 per drug regimen (0.29-11% of a regimen's drug cost of $360-15,028). In a multivariable regression analysis, an additional treatment month increased the import cost of a drug regimen by $5.45 (95% CI: 1.65 to 9.26). Use of an injectable antibiotic in a regimen increased the import cost by $133 (95% CI: 47 to 219). The variable and potentially sizable import costs of TB regimens can affect the financial needs of TB programs. Drug regimens that are shorter and all-oral tend to reduce import costs compared to longer regimens and regimens including an injectable drug.
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http://dx.doi.org/10.1371/journal.pgph.0000567 | DOI Listing |
Front Parasitol
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Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands.
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Faculty of Medicine, UNSW Sydney, St Vincent's Clinical School, Sydney, New South Wales, Australia.
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National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China.
Background: China's Expanded Program on Immunization (EPI) provides vaccinations against 12 vaccine preventable diseases (VPDs) at no cost to families. For some VPDs, parents may opt to substitute equivalent non-program vaccines, including combination vaccines, for EPI vaccines; substitute vaccines must be paid for by the family. Although parents have several choices for vaccinating their children, their preferences for vaccines and immunization schedules have not been systematically evaluated.
View Article and Find Full Text PDFSci Data
January 2025
School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham, UK.
Cities exhibit diverse urban metabolism patterns in terms of the natural environment, industrial composition, energy, and material consumption. A chronicled city-level quantification of emergy metabolic flows over time can significantly enhance the understanding of the temporal dynamics and urban metabolism patterns, which provides critical insights for the transitions to sustainability. However, there exists no city-level urban emergy metabolism dataset in China that can support detailed spatial-temporal analysis.
View Article and Find Full Text PDFFront Plant Sci
December 2024
Department of Animal Biology, Soil Science and Geology, University of La Laguna, San Cristóbal de La Laguna, Spain.
The scarcity, unstable nutritional quality and environmental cost of imported forages in arid insular regions like Fuerteventura in the Canary Islands (Spain) need exploring sustainable local alternatives. This study evaluated the nutritional quality of twelve native and endemic plant species categorized into legumes, grasses, and a mixed group, cultivated under controlled conditions. The bromatological profiles, focusing on fiber, protein, lipids, and minerals, showed significant differences among plants in key parameters of forage quality: neutral detergent fiber (NDF; 24.
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