Zhongfei Pei 1,2 , Sok King Ong 3 , Siyan Yi 4,5,6 , Chitin Hon7 , Ming Xu1,2,∗

1 Department of Global Health, School of Public Health, Peking University, Beijing, China

2 Institute for Global Health and Development, Peking University, Beijing, China

3 PAPRSB Institute of Health Sciences, University Brunei Darussalam, Jln Tungku Link, Bandar Seri Begawan, Brunei Darussalam

4 Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore

5 KHANA Centre for Population Health Research, Khmer HIV/AIDS NGO Alliance, Phnom Penh, Cambodia

6 Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, USA

7 Respiratory Disease AI Laboratory in Epidemic Intelligence and Applications of Medical Big Data Instruments, Faculty of Innovation Engineering, Macau

University of Science and Technology, Taipa, Macau SAR, China

This study aimed to investigate the consumption trends and accessibility of anti-tuberculosis (TB) drugs in nine countries in the Asia-Pacific region (Bangladesh, China, India, Indonesia, Malaysia, Pakistan, Philippines, Thailand, and Vietnam) between 2019 and 2022. The study analyzed consumption data for 17 TB drugs using drug sales databases such as IQVIA-MIDAS, PDB, and RPDB, and linked these data to TB incidence rates and several health economic indicators. The study revealed significant differences in drug accessibility across the Asia-Pacific region. In 2022, the median consumption of TB drugs in low- and middle-income economies (LMIEs) (2157 SU/1000 cases) was significantly lower than in high- and middle-income economies (UMIEs, 14417 SU/1000 cases). First-line drugs accounted for over 90% of total sales in all studied countries. Although newer multidrug-resistant TB (MDR-TB) drugs (such as bedaquiline and delamani) have been introduced, their availability in the Asia-Pacific region is extremely low, with sales in only six countries. Between 2019 and 2022, the compound annual growth rate (CAGR) of consumption in various countries fluctuated between -39.2% and +58.2%. Countries like Pakistan and Vietnam experienced significant declines, while the Philippines and Indonesia showed marked growth trends. The study indicates that achieving the goals of the "End Tuberculosis Strategy" in the Asia-Pacific region still faces significant challenges. Lower drug consumption often reflects a large gap in case detection and treatment coverage, rather than simply a matter of economic affordability. Therefore, it is urgent to eliminate regional inequalities and ensure that resource-constrained areas can also access advanced treatment options through accelerated drug regulatory approvals, strengthened public-private sector collaboration (especially in private healthcare systems), and continued international resource support. 

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