Table 3 Expert perspectives on the disadvantages of introducing TACTs over current practices of rotating ACTs when treatment failure is observed in Southeast Asia
Disadvantages | Explanation | n |
|---|---|---|
More expensive | TACTs could be more expensive than current ACTs | 36 |
Additional side effects | TACTs could cause additional side-effects such as vomiting, fatigue and headache | 25 |
Unavailability of FDC TACTs | TACTs are not yet available in fixed-dose combinations (FDCs) and FDC product-development timelines could be long | 17 |
Losing drug compounds | TACTs could jeopardize the efficacy of current drug compounds and increase the speed of resistance spreading | 14 |
Toxicity/safety risks | TACTs could increase safety risks, (cardio)toxic effects and negative drug-drug interactions | 14 |
Increasing pill burden | TACTs could have an increased pill burden which may increase the risk of non-compliance | 13 |
Implementation time and costs | TACTs rollout and implementation could be time and resource intensive | 11 |
Limited evidence available | TACTs’ safety and efficacy are not yet scientifically proven | 11 |
Small market size | TACTs could be considered unattractive for pharmaceutical companies because of the limited market size for antimalarials in Southeast Asia | 6 |
Limited timeframe for use | TACTs timeframe for use could be too narrow to warrant the investments in the context of increasing drug resistance and receding falciparum malaria | 5 |
Pharmacovigilance requirements | TACTs implementation could require increased investments in pharmacovigilance systems | 3 |
Reducing sense of urgency | TACTs deployment could reduce the sense of urgency in discovering new drug compounds | 2 |
Limited efficacy | TACTs could have limited clinical response when the individual drug compounds are already failing | 1 |
Limiting credibility of ACTs | TACTs deployment in Southeast Asia could reduce the perceived credibility of ACTs elsewhere | 1 |
Multiple TACTs required | TACTs could not be a 'one size fits all' solution, instead multiple TACTs are required because of a variety in drug resistance profiles | 1 |