Abstract
BackgroundLess than one-third of patients who are estimated to be infected with multidrug-resistant tuberculosis (MDR-TB) receive MDR-TB treatment regimens, and only 48% of those who received treatment have successful outcomes. Despite current regimens, newer, more effective and cost-effective approaches to treatment are needed. The aim of the study was to project health outcomes and impact on healthcare resources of adding bedaquiline to the treatment regimen of MDR-TB in selected high burden countries: Estonia, Russia, South Africa, Peru, China, the Philippines, and India.MethodsThis study adapted an existing Markov model to estimate the health outcomes and impact on total healthcare costs of adding bedaquiline to current MDR-TB treatment regimens. A price threshold analysis was conducted to determine the price range at which bedaquiline would be cost-effective.ResultsAdding bedaquiline to the background regimen (BR) resulted in increased disability-adjusted life years (DALYs) averted, and reduced total healthcare costs (excluding treatment acquisition costs) compared with BR alone in all countries analyzed. Addition of bedaquiline to BR resulted in savings to healthcare costs compared with BR alone in all countries analyzed, with the highest impact expected in Russia (US$194 million) and South Africa (US$43 million). The price per regimen at which bedaquiline would be cost-effective ranged between US$23,904-US$203,492 in Estonia, Russia, Peru, South Africa, and China (high and upper middle-income countries) and between US$6,996-US$20,323 in the Philippines and India (lower middle-income countries); however, these cost-effective prices do not necessarily address concerns about affordability.ConclusionsAdding bedaquiline to BR provides improvements in health outcomes and reductions in healthcare costs in high MDR-TB burden countries. The range of prices per regimen for which bedaquiline would be cost-effective varied between countries.
Highlights
Less than one-third of patients who are estimated to be infected with multidrug-resistant tuberculosis (MDR-TB) receive MDR-TB treatment regimens, and only 48% of those who received treatment have successful outcomes
The highest incremental change in Disability adjusted life years (DALY) was observed in China where the introduction of bedaquiline to the background regimen (BR) was associated with just 8.87 DALYs per patient compared to 11.86 DALYs per patient with BR alone
In the high- and upper middle-income countries (Estonia, Russia, South Africa, Peru and China), between 31.34% and 40.80% fewer cases of acquired resistance were observed when bedaquiline was added to the BR compared with BR alone
Summary
Less than one-third of patients who are estimated to be infected with multidrug-resistant tuberculosis (MDR-TB) receive MDR-TB treatment regimens, and only 48% of those who received treatment have successful outcomes. Multidrug-resistant tuberculosis (MDR-TB), defined as tuberculosis caused by strains resistant to isoniazid and rifampicin, poses challenges to global TB control. Drug-resistant TB (XDR-TB), caused by MDR-TB strains that are resistant to any fluoroquinolone and to at least one of the three injectable second-line drug classes (aminoglycosides, polypeptides, fluoroquinolones, thioamides, cycloserine, and para-aminosalicyclic acid) [1] may result in even poorer outcomes compared with MDR-TB [2]. Bedaquiline received accelerated and conditional approval in the United States and Europe, respectively, for the treatment of pulmonary MDR-TB in combination with other anti-tuberculosis drugs when an effective treatment regimen cannot otherwise be provided [4, 5]. The World Health Organization (WHO) subsequently issued interim guidance for use of bedaquiline in adult patients with pulmonary MDR-TB [6]
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