Global access to antifungal therapy and its variable cost.

BACKGROUND: Antifungal therapy saves lives, if given early in life-threatening invasive infection, and also greatly reduces morbidity in hundreds of millions of patients worldwide.

OBJECTIVES: We have partially mapped by country systemic generic antifungal drug registration, availability and daily cost for intravenous deoxycholate amphotericin B (50 mg), flucytosine (5 g), oral fluconazole (750-800 mg) and oral itraconazole (400 mg).

METHODS: Multiple publically available resources and local country contacts provided data for 159 countries with populations >1 million.

RESULTS: Amphotericin B is not licensed in and unavailable in 22 of 155 (14.2%) and 42 of 155 (27.1%) countries, respectively, representing an unserved population of 481 million. The daily price of deoxycholate amphotericin B varied from <$1 to $171. Fluconazole was licensed in all 141 (88.6%) countries for which data were available although 2 countries appear wholly dependent on the Diflucan® Partnership Program, which is restricted to HIV/AIDS patients. The daily price of fluconazole varied from <$1 to $31. Itraconazole is not licensed in and unavailable in at least 3 of 123 (2.4%) and 5 of 125 (4.0%) countries, respectively, representing an unserved population of at least 78 million. The daily price of itraconazole varied from <$1 to $102. Flucytosine is not licensed in and is unavailable in 89 of 125 (71.2%) and 95 of 125 (76.0%) countries, respectively, representing an unserved population of 2898 million. The daily price of flucytosine varied from $4.60 to $1409.

CONCLUSIONS: National governments without access to antifungal drugs should address this health system deficiency urgently to improve clinical outcomes from serious fungal disease. The variability in the price of antifungals between countries is striking.