Abstract
ObjectiveTo evaluate the cost-effectiveness of adding bedaquiline to a background regimen (BR) of drugs for multidrug-resistant tuberculosis (MDR-TB) in the United Kingdom (UK).MethodsA cohort-based Markov model was developed to estimate the incremental cost-effectiveness ratio of bedaquiline plus BR (BBR) versus BR alone (BR) in the treatment of MDR-TB, over a 10-year time horizon. A National Health Service (NHS) and personal social services perspective was considered. Cost-effectiveness was evaluated in terms of Quality-Adjusted Life Years (QALYs) and Disability-Adjusted Life Years (DALYs). Data were sourced from a phase II, placebo-controlled trial, NHS reference costs, and the literature; the US list price of bedaquiline was used and converted to pounds (£18,800). Costs and effectiveness were discounted at a rate of 3.5% per annum. Probabilistic and deterministic sensitivity analysis was conducted.ResultsThe total discounted cost per patient (pp) on BBR was £106,487, compared with £117,922 for BR. The total discounted QALYs pp were 5.16 for BBR and 4.01 for BR. The addition of bedaquiline to a BR resulted in a cost-saving of £11,434 and an additional 1.14 QALYs pp over a 10-year period, and is therefore considered to be the dominant (less costly and more effective) strategy over BR. BBR remained dominant in the majority of sensitivity analyses, with a 81% probability of being dominant versus BR in the probabilistic analysis.ConclusionsIn the UK, bedaquiline is likely to be cost-effective and cost-saving, compared with the current MDR-TB standard of care under a range of scenarios. Cost-savings over a 10-year period were realized from reductions in length of hospitalization, which offset the bedaquiline drug costs. The cost-benefit conclusions held after several sensitivity analyses, thus validating assumptions made, and suggesting that the results would hold even if the actual price of bedaquiline in the UK were higher than in the US.
Highlights
Multidrug-resistant tuberculosis (MDR-TB), a disease caused by strains of TB that are resistant to the two most important first-line anti-TB drugs, isoniazid and rifampicin, is a growing public health problem [1]
Over the 10-year time horizon, the total discounted cost and discounted Quality-Adjusted Life Years (QALYs) for the single cohort of 20 patients assigned to bedaquiline plus background regimen (BR) was £2,170,394 and 105.09 QALYs, using the US list price for bedaquiline of £18,800 (Table 3)
For each patient treated with bedaquiline, the average cost-saving versus standard of care (BR alone) was £11,434 over a 10-year time period
Summary
Multidrug-resistant tuberculosis (MDR-TB), a disease caused by strains of TB that are resistant to the two most important first-line anti-TB drugs, isoniazid and rifampicin, is a growing public health problem [1]. In the UK, the incidence of drug-susceptible TB (DS-TB) has held steady at approximately 9,000 cases per year over the last decade, while a gradual but considerable increase in the proportion of drug-resistant TB has been observed [2]. The adequate and appropriate treatment of MDR-TB is of growing public health concern, and improved treatment strategies may be required to treat complex cases of MDR-TB. MDR-TB is difficult to treat, typically requiring a regimen of toxic and poorly tolerated second-line anti-TB drugs, including injectable drugs, for a period of 18 to 24 months [4,5,6]. There is a clear need for new treatments that improve treatment outcomes in a higher proportion of patients with MDR-TB [8,9]
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