Johnson & Johnson Global Public Health, New Brunswick, NJ, USA.
Janssen Pharmaceutical South Africa, Pharmaceutical Division of Johnson and Johnson, Johannesburg, South Africa.
Expert Rev Anti Infect Ther. 2020 May;18(5):475-483. doi: 10.1080/14787210.2020.1742109. Epub 2020 Mar 18.
: Bedaquiline-containing regimens have demonstrated improved outcomes over injectable-containing regimens in the long-term treatment of multidrug-resistant tuberculosis (MDR-TB). Recently, the World Health Organization (WHO) recommended replacing injectables in the standard short-course regimen (SCR) with a bedaquiline-containing regimen. The South African national TB program similarly recommends a bedaquiline-containing regimen. Here, we investigated the cost-effectiveness of a bedaquiline-containing SCR versus an injectable-containing SCR for the treatment of MDR-TB in South Africa.: A Markov model was adapted to simulate the incidence of active patients with MDR-TB. Patients could transition through eight health states: active MDR-TB, culture conversion, cure, follow-up loss, secondary MDR-TB, extensively DR-TB, end-of-life care, and death. A 5% discount was assumed on costs and outcomes. Health outcomes were expressed as disability-adjusted life years (DALYs).: Over a 10-year time horizon, a bedaquiline-containing SCR dominated an injectable-containing SCR, with an incremental saving of US $982 per DALY averted. A bedaquiline-containing SCR was associated with lower total costs versus an injectable-containing SCR (US $597 versus $657 million), of which US $3.2 versus $21.9 million was attributed to adverse event management.: Replacing an injectable-containing SCR with a bedaquiline-containing SCR is cost-effective, offering a cost-saving alternative with improved patient outcomes for MDR-TB.
: 包含贝达喹啉的方案在耐多药结核病（MDR-TB）的长期治疗中，相较于包含注射剂的方案，在改善结局方面显示出了优势。最近，世界卫生组织（WHO）建议用包含贝达喹啉的方案替代标准短程化疗方案（SCR）中的注射剂。南非国家结核病规划也建议使用包含贝达喹啉的方案。在此，我们研究了南非使用包含贝达喹啉的 SCR 方案与使用包含注射剂的 SCR 方案治疗 MDR-TB 的成本效益。: 我们采用马尔可夫模型来模拟耐多药结核病活动患者的发病率。患者可在八种健康状态之间转换：耐多药结核病活动期、培养转阴、治愈、随访丢失、继发性耐多药结核病、广泛耐药结核病、临终关怀和死亡。假设成本和结果均有 5%的折扣。健康结果用残疾调整生命年（DALYs）表示。: 在 10 年的时间范围内，包含贝达喹啉的 SCR 方案优于包含注射剂的 SCR 方案，每避免一个 DALY 可额外节省 982 美元。相较于包含注射剂的 SCR 方案，包含贝达喹啉的 SCR 方案总成本更低（5.97 亿美元对 6.57 亿美元），其中 3200 万美元对 2.19 亿美元归因于不良事件管理。: 用包含贝达喹啉的 SCR 方案替代包含注射剂的 SCR 方案具有成本效益，为耐多药结核病患者提供了更优的治疗选择，同时还节约了成本，改善了患者结局。
