Health outcomes of bedaquiline in the treatment of multidrug-resistant tuberculosis in selected high burden countries

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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1931-3) contains supplementary material, which is available to authorized users.

Managing Uncertainties Due to Limited Evidence in Economic Evaluations of Novel Anti-Tuberculosis Regimens: A Systematic Review

“…The scenario analyses performed in the empirical study could only inform decision makers on the cost drivers of implementing the bedaquiline-based regimens. As observed in other studies, the use of bedaquiline mainly reduced the hospitalization costs due to the rapid culture conversion that allowed early discharge from inpatient care [27][28][29]. The study also showed significant cost saving due the elimination of costs for the management of injectable-related adverse events.…”

New drugs and regimens for tuberculosis

“…(6) Cohort‐based Markov models and cohort‐based decision‐analytic model have demonstrated it is cost‐effective to add bedaquiline to a background MDR‐TB treatment regimen…”

Bedaquiline: Fallible Hope Against Drug Resistant Tuberculosis

“…To add to the benefits of including BDQ in the anti-TB regimens a study was done using the cohort-based Markov state transition model simulated for a period of 10 years. This assessed the health and economic effects of the background regimen (BR) with or without BDQ and concluded that adding BDQ to BR provides improvements in health outcomes and reductions in healthcare costs in high MDR-TB burden countries [33]. As per CDC guidelines, BDQ can be effectively included into the anti-TB drug regimen to treat MDR infected children when ''an effective treatment regimen cannot otherwise be provided'' [34].…”