Details of research question #4: Modelling to Understand the Epidemiological Impact and Market Impact of Harmonized Regimens for MDR-TB
The lack of harmonization of treatment regimens for MDR-TB both within and among countries results in fragmentation of overall demand for MDR-TB medicines and hurts the market. There have been some efforts to harmonize and rationalize regimens but some argue that different regimen options are required in order to adapt treatment for each individual patient’s needs and the resistance patterns in a country or region. There is no clear or objective way to capture the population level health benefits that result from more specific regimens. On the other hand it is clear that more fragmented markets leads to higher prices, longer lead times and a less sustainable market for MDR-TB medicines. New regimens for MDR-TB or TB more generally will be introduced in this context.
Traditionally, separate modelling approaches have been used to project the impact of using treatment regimens on MDR-TB disease dynamics and to understand the market impact of using more harmonized regimens. Assessing the total effect of harmonizing regimens requires explicitly capturing the impact of this at the population level and for the market as a whole.
An urgent need has been identified for a new type of model which includes the dynamic epidemiological effects of treatment harmonization and the market impacts of treatment harmonization with feedback loops to capture the inter-relationships. A combined model is needed that captures the most important features of both the market side and the epidemiological characteristics. Such a model should be calibrated to existing epidemiological data and market parameters such as price.
The model should include 1) A disease progression model that includes resistance spread (2) A market impact model that considers differences in prices between products and potentially decrease in prices as a result of volume shift. The time horizon of the model should be: 5-10 years. The geography and scale is: 1 large MDR-TB high burden country e.g. Russia or China where there sufficient data on resistance patterns for second-line drugs. The model structure should be usable for other countries and scaleable to be a global model. The first phase parameterization and validation could be done for the selected country.
To develop model(s) that project the epidemiological impact and market impact of harmonizing treatment regimens for MDR-TB, including new regimens, within a particular country and across countries
1. To develop a model that included a disease progression model that includes resistance spread and a market impact model that considers differences in prices between products and potentially decrease in prices as a result of volume shift.
2. To parameterize and validate the model for a selected country.
3. To make projections over 5-10 years in at least 1 large MDR-TB high burden country
4. Show that the model structure is usable for other countries and scaleable to a global model.
All applications will be reviewed by expert reviewers. All applications to this research question will be scored against the following criteria:
- Is the research question and plan well-described
- Is the research team qualified to conduct this research
- Is the budget and timeline appropriate for the proposed activity
- Is the proposal likely to meet the aim and objectives outlined in the RFA
- Is the dissemination and impact maximisation plan adequate
- Does the proposal explain how models and data will be shared for maximum public utility