Abstract
Background: Multidrug Resistant Tuberculosis (MDR-TB) remains a burden on the healthcare system and public health. Evidence on cost and cost-effectiveness of MDR-TB treatment option is necessary in order to provide evidence-based recommendation for policymakers. The main therapy for MDR-TB consists of a combination of at least five types of anti-tuberculosis drugs, including second-line injections that have proven to be effective. Bedaquiline is a relatively new drug recommended by the World Health Organization (WHO) and European Medicines Agency (EMA) for the treatment of MDR-TB. Aims and Objectives: This study examines the cost-effectiveness of using regimens containing bedaquiline compared to those containing second-line injections. Methods: The design of this study is a literature review study. The following keywords used for the search were: “MDR-TB,” “cost effectiveness analysis of MDR-TB,” “cost effectiveness analysis of MDR-TB patients,” “WHO guideline for MDR-TB,” “Bedaquiline cost effectiveness,” and “kanamycin cost effectiveness.” The relevant references were derived from several databases, including PubMed, NCBI, and the Journal of Indonesian Health Economics. A total of 170 articles were obtained during the initial search, then extracted with inclusion criteria, namely articles assessing cost effectiveness, QALY, DALY, articles in English and Indonesian, and publications within the last 10 years. Results: The addition of bedaquiline in standard therapy showed favourable effect and safety due to faster culture conversion time and less incidence of side effects, based on the results of studies. The faster the culture conversion occurs and the less patients experiencing side effects, the faster their health improvement, which prospectively will reduce treatment costs and productivity loss. Conclusion: This is demonstrated by the results of cost-effectiveness analysis which shows that the replacement of the second-line injection regimen to bedaquiline, and the addition of bedaquiline to the standard regimen of therapy was assessed to be a more cost-effective option.
Highlights
IntroductionStudies in Armenia showed that the mean time to culture conversion in the bedaquiline group was 2.7 months earlier than the standard group, namely 5.7 months
The faster the culture conversion occurs and the less patients experiencing side effects, the faster their health improvement, which prospectively will reduce treatment costs and productivity loss. This is demonstrated by the results of cost-effectiveness analysis which shows that the replacement of the second-line injection regimen to bedaquiline, and the addition of bedaquiline to the standard regimen of therapy was assessed to be a more cost-effective option
The bedaquiline group was able to prevent 0.17 Disability-Adjusted Life Years (DALY) compared to the standard group who received an additional fee of US$1242 (I$1242) per DALY [8]
Summary
Studies in Armenia showed that the mean time to culture conversion in the bedaquiline group was 2.7 months earlier than the standard group, namely 5.7 months. In the cost effectiveness side, there is one study in Africa that showed that the average cost of treatment per patient in the bedaquiline group was 4.3% higher by US$4647 (I$4647) than the standard group of US$4439 (I$4439). The bedaquiline group was able to prevent 0.17 DALY compared to the standard group who received an additional fee of US$1242 (I$1242) per DALY [8] Another comparable study in Africa showed that the average cost of treating the bedaquiline group was US$49.07 (I$49.07) lower than the standard group, which was US$332.78 (I$332.78) per patient. Bedaquiline is a relatively new drug recommended by the World Health Organization (WHO) and European Medicines Agency (EMA) for the treatment of MDR-TB
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