Doctors Without Borders (MSF) has acknowledged the lower price offered to the government of South Africa for the newer anti-tuberculosis drug delamanid. MSF is a non-profit organisation that seeks to bring health care to countries in crisis. The body calls for the price of the drug to be significantly lower and expanded to all countries in need. Mylan, which licenses the drug from the patent-holder Otsuka, will charge about R14 000 for a six-month treatment course (about R2 300 per month) in South Africa as of 1 June 2020. Delamanid is used in combination with other drugs to treat people with drug-resistant tuberculosis (DR-TB), as well as the hard to treat extensively drug-resistant tuberculosis (XDR-TB). The request for the price review came after findings by researchers who have confirmed that delamanid could be produced and sold at a profit for much less – from about R74 to R237 per month – if the TB programmes scale up the use of the drug. “Even at about R14 000, delamanid remains one of the most expensive DR-TB drugs, and its high price will continue to have a chilling effect on the scale-up of this drug in national TB programmes,” said Dr Stobdan Kalon, MSF medical advisor in India. He said delamanid was one of the most expensive drugs used to treat DR-TB, priced at approximately R25 000 for a six-month treatment course (R4 000 a month) through the Global Drug Facility (GDF), a TB drug and diagnostic procurement mechanism operating out of a United Nations agency.“It is just one of multiple drugs needed to treat the disease. Its high price is a key driver of the high overall cost of treating people with MDR-TB and XDR-TB,” said Kalon. “A full 20-month treatment course for one person can cost nearly R120 000 to R180 000 through the GDF, depending upon the length of treatment and the other drugs that make up the treatment regimen.” Although delamanid was conditionally approved by the European Medicines Agency in April 2014, as of the end of August 2019, only 2 902 people had ever been treated with delamanid according to the DR-TB Scale-Up Treatment Action Team of global TB experts, which receives updates from the National TB Programmes and large treatment providers, such as the MSF.