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. 2015 Mar 20;10(3):e0120763.
doi: 10.1371/journal.pone.0120763. eCollection 2015.

Cost-effectiveness of adding bedaquiline to drug regimens for the treatment of multidrug-resistant tuberculosis in the UK

Lara J Wolfson  1 , Anna Walker  2 , Robert Hettle  2 , Xiaoyan Lu  1 , Chrispin Kambili  3 , Andrew Murungi  4 , Gerhart Knerer  4
Affiliations

Cost-effectiveness of adding bedaquiline to drug regimens for the treatment of multidrug-resistant tuberculosis in the UK

Lara J Wolfson et al. PLoS One. .

Abstract

Objective: To 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).

Methods: A 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.

Results: The 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.

Conclusions: In 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.

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Conflict of interest statement

Competing Interests: The authors have the following interests: L.J. Wolfson and X. Lu were employed by Janssen Pharmaceutica N.V. at the time of writing this manuscript; C. Kambili was employed by Janssen Global Services LLC; and G. Knerer and A. Murungi were employed by Janssen-Cilag. R. Hettle and A. Walker were commissioned by Janssen Pharmaceutica N.V. to prepare the cost-effectiveness model that this manuscript is based on. Anna Walker and Robert Hettle are employed by HERON™ Commercialization. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Markov model state structure.
MDR-TB: multi-drug resistant tuberculosis; TB: tuberculosis. *Transitions to the death state are possible from every state, but not shown on the diagram for clarity.
Fig 2
Fig 2. Cost-effectiveness plane for bedaquiline + BR versus BR only from a UK NHS and PSS perspective.
BR: background regimen; NHS: National Health Service; PSS: Personal Social Services; QALY: quality adjusted life-year
Fig 3
Fig 3. Cost-effectiveness acceptability curve for bedaquiline + BR versus BR only from a UK payer perspective (assuming price of £18,800 per treatment course).
BR: background regimen
Fig 4
Fig 4. Tornado diagram representing deterministic sensitivity analysis based on incremental cost per QALY.
* Fixed ranges of +/- 20% were chosen due to the lack of available ranges in the literature. BR: background regimen; ICER: incremental cost-effectiveness ratio; QALY: quality adjusted life-year; TB: tuberculosis
See this image and copyright information in PMC

References

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