Product costs of fixed-dose combination tablets in comparison with separate dispensing and or co-blistering of antituberculosis drugs

Current recommendations for the treatment of tuberculosis emphasize the use of short‐course multidrug chemotherapy under proper supervision. Since the mid‐ 1990s the World Health Organization (WHO) has promoted directly observed treatment short‐course (DOTS) as the global strategy of treating tuberculosis (1). The DOTS strategy has been shown to increase cure rates, reduce the risk of emergence of drug resistance and prevent relapse (2,3). In resource‐poor countries there is often freqent and serious lack of adequate funding of the national tuberculosis program, which hampers the implementation or expansion of DOTS. The impact of poor drug supply in diseases such as tuberculosis and HIV does have far‐reaching public health consequences. Drugs are essential to prevent and cure tuberculosis. The inadequate and irregular supply of antituberculosis drugs could fuel the emergence of multidrug resistance. Patients treated for tuberculosis need to take a large number of tablets every day for long periods of time, which carries the risk of patients becoming non‐compliant. Blister packing in tuberculosis control has been promoted as a way of facilitating patient compliance (4). Also fixed‐ dose compounds (FDCs) as an integral part of the DOTS strategy provide additional patient management options for tuberculosis by decreasing the number of tablets a patient takes and increasing chances of completing treatment. In 1994 the WHO and the International Union Against Tuberculosis and Lung Disease (IUATLD) recommended the use of FDC tablets for treatment of tuberculosis (5,6). In 1999 the WHO Model List of Essential Drugs was updated to include a four‐drug FDC in the recommended formulation (7). One advantage of the 4‐drug FDC is the greater reliability with which tuberculosis programs can deliver short‐course multidrug treatment (8).