Tuberculosis Burden Remains High

BMI View: While prevalence rates can provide much insight on the extent of a disease in a country, the data can be very patchy - particularly in developing countries that do not have the resources to record data accurately and consistently. Alternatively, BMI highlights that disability-adjusted life years (DALYs) is another indicator that can be used by pharmaceutical firms, government agencies and healthcare providers to understand shortcomings in terms of access to drugs. This in turn enables companies and authorities to plan investments and policies accordingly.

The World Health Organization (WHO) has released the 'Global Tuberculosis (TB) Report 2013'. The report shows that instances of new TB cases has been falling globally, although the rate of decline - just 2% annually - remains slow. Other findings include:

  • The Americas and Western Pacific regions achieved their 2015 targets to reduce incidence, prevalence and mortality of TB. However, the African and European regions are not on track to achieve these targets.

  • Cambodia Has Highest TB Prevalence
    TB Prevalence Rate (Per 100,000 Population) In Selected Asian Countries

BMI View: While prevalence rates can provide much insight on the extent of a disease in a country, the data can be very patchy - particularly in developing countries that do not have the resources to record data accurately and consistently. Alternatively, BMI highlights that disability-adjusted life years (DALYs) is another indicator that can be used by pharmaceutical firms, government agencies and healthcare providers to understand shortcomings in terms of access to drugs. This in turn enables companies and authorities to plan investments and policies accordingly.

The World Health Organization (WHO) has released the 'Global Tuberculosis (TB) Report 2013'. The report shows that instances of new TB cases has been falling globally, although the rate of decline - just 2% annually - remains slow. Other findings include:

  • The Americas and Western Pacific regions achieved their 2015 targets to reduce incidence, prevalence and mortality of TB. However, the African and European regions are not on track to achieve these targets.

  • Progress on meeting targets for the diagnosis and treatment of multi-drug resistant TB (MDR-TB) is behind schedule.

  • As of 2012, the TB mortality rate had been reduced by 49% from 1990. As a result, the target to reduce deaths by 50% by 2015 is within reach.

  • In 2012, approximately 450,000 people developed MDR-TB, while 170,000 people died from MDR-TB.

  • The majority of TB cases worldwide were in the South East Asia (29%), African (27%) and Western Pacific regions (19%). India and China accounted for 26% and 12% of total cases respectively.

  • In Asia, countries with a high TB burden include: Afghanistan, Bangladesh, Cambodia, China, India, Indonesia, Myanmar, Pakistan, Philippines, Thailand and Vietnam.

Cambodia Has Highest TB Prevalence
TB Prevalence Rate (Per 100,000 Population) In Selected Asian Countries

The Challenge Of Interpreting Disease Data

Pharmaceutical firms often seek prevalence data to decide which countries or therapeutic areas to focus their products on. However, prevalence data, while useful, has its limitations. Global organisations maintain three main prevalence databases on cancer (International Agency For Research On Cancer- Globocan), diabetes (International Diabetes Federation - Diabetes Atlas) and tuberculosis (WHO- Global Tuberculosis Report). While these reports provide an overview of global disease prevalence globally, it must be noted that some of the data are extrapolated from outdated figures. For example, in the case of Cambodia, WHO stated that 'estimates of TB and MDR-TB burden are produced by WHO in consultation with country.' Meanwhile in the case of India, the report stated that 'estimates for India have not yet been officially approved by the Ministry of Health & Family Welfare, Government of India and should therefore be considered provisional.'

Instead, BMI advocates that pharmaceutical firms, governments and other relevant agencies look at the burden of diseases and its impact on the economy and health system, using disability-adjusted life years (DALYs) as an indicator. DALYs is a health gap measure that extends the concept of potential years of life lost due to premature death (PYLL) to include equivalent years of 'healthy' life lost by virtue of being in states of poor health or disability. According to BMI's Burden of Disease Database (BoDD), in 2012, the two countries with the highest DALYs lost to TB were Cambodia and Indonesia. By 2025, we forecast that the Indonesia will have the highest burden of TB compared to these countries.

Indonesia Will Have Highest TB Burden
DALYs Per '000 Population Lost To Tuberculosis In Selected Asian Countries

Disparity between prevalence rate and DALYs can be attributed to a number of factors, including a patient's access to healthcare services, rate of TB diagnosis, cost of TB treatments, availability of new TB drugs, aid from non-government organisations (NGOs) and government policies in TB prevention. Consequently, while India has a relatively low TB prevalence rate, its high burden of TB indicates shortcomings in terms of patients' access to TB treatment and diagnosis in comparison with the Philippines, for example.

In addition to recognising the value of DALYs, companies also need to assess different countries' business environments before committing to investments. In the case of TB, both prevalence numbers and DALYs data show that Cambodia will be the best location for pharmaceutical investment or drug launches, due to clear unmet TB needs. However, Cambodia has low overall pharmaceutical and per-capita pharmaceutical expenditures, as well as high political risk, corruption and extensive bureaucracy, making the country a tough environment for pharmaceutical firms.

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Related sectors of this article: Pharmaceuticals & Healthcare
Geography: Asia, China
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