Cost-effectiveness of BPaL/BPaLM as compared to mixed standard of care bedaquiline containing regimen for MDR/RR-TB.
Abstract
Background & objectives Current options for treating tuberculosis (TB) that is resistant to rifampicin (RR-TB) are limited and available regimens are often lengthy and poorly tolerated. However, following recent evidence from the TB PRACTECAL trial, countries are considering programmatic adoption of six-month, all-oral treatment regimen such as bedaquiline, pretomanid, linezolid (BPaL) and BPaL with moxifloxacin (BPaLM). We conducted an economic evaluation to assess whether the introduction of BPaL/BPaLM regimen under National Tuberculosis Elimination Programme (NTEP) for the treatment of multi-drug resistant (MDR)/RR-TB is a cost-effective strategy. The idea was to estimate the incremental cost incurred from BPaL/BPaLM regimen in comparison with the current mix of standard of care (SoC) regimen. Methods We used an economic model comprising a Markov analysis. The study estimated the incremental costs, life years gained and quality adjusted life years (QALYs) gained by the introduction of BPaL/BPaLM regimen for MDR/RR-TB patients. A scenario analysis for different proportions of shorter and longer SoC regimen compared with BPaL/BPaLM was also done. Cost threshold analysis was done to assess the ideal cost at which the drug BPaL/BPaLM turns into cost-saving. Budget impact analysis was conducted to assess the financial implications of adopting BPaL/BPaLM compared to mix SoC, supporting informed decision-making alongside cost-effectiveness analysis for one year. Results The base…
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