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

Abstract

Background: 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. 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.

Methods: This 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.

Results: Adding 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.

Conclusions: Adding 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.

Keywords: Cost-effectiveness threshold; DALY.

Fig. 1

Outline of the Markov model assessing health outcomes of bedaquiline in high burden countries Source: adapted from [9] CE: cost-effectiveness; MDR-TB: multidrug-resistant tuberculosis; XDR-TB: extensively drug-resistant tuberculosis. Note: MDR-TB population includes patients with MDR-TB as well as XDR-TB patients; transitions to the death state are possible from every state, but not shown on the diagram for clarity

Fig. 2

Probability that bedaquiline plus BR will be cost-effective compared with BR alone. conducted to assess whether the addition of bedaquiline to BR, for a range of different prices that satisfy the WHO CE threshold (3x GDP), would be cost-effective. BR: background regimen; CE: cost-effectiveness; GDP: gross domestic product; WHO: World Health Organization