Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
Modelling, Epidemiology and Data Science Department, Sanofi Pasteur, Lyon, France.
BMJ Open. 2021 Dec 3;11(12):e051521. doi: 10.1136/bmjopen-2021-051521.
Patients with highly resistant tuberculosis have few treatment options. Bedaquiline, pretomanid and linezolid regimen (BPaL) is a new regimen shown to have favourable outcomes after six months. We present an economic evaluation of introducing BPaL against the extensively drug-resistant tuberculosis (XDR-TB) standard of care in three epidemiological settings.
Cost-effectiveness analysis using Markov cohort model.
South Africa, Georgia and the Philippines.
XDR-TB and multidrug-resistant tuberculosis (MDR-TB) failure and treatment intolerant patients.
BPaL regimen. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Incremental cost per disability-adjusted life years averted by using BPaL against standard of care at the Global Drug Facility list price. (2) The potential maximum price at which the BPaL regimen could become cost neutral.
BPaL for XDR-TB is likely to be cost saving in all study settings when pretomanid is priced at the Global Drug Facility list price. The magnitude of these savings depends on the prevalence of XDR-TB in the country and can amount, over 5 years, to approximately US$ 3 million in South Africa, US$ 200 000 and US$ 60 000 in Georgia and the Philippines, respectively. In South Africa, related future costs of antiretroviral treatment (ART) due to survival of more patients following treatment with BPaL reduced the magnitude of expected savings to approximately US$ 1 million. Overall, when BPaL is introduced to a wider population, including MDR-TB treatment failure and treatment intolerant, we observe increased savings and clinical benefits. The potential threshold price at which the probability of the introduction of BPaL becoming cost neutral begins to increase is higher in Georgia and the Philippines (US$ 3650 and US$ 3800, respectively) compared with South Africa (US$ 500) including ART costs.
Our results estimate that BPaL can be a cost-saving addition to the local TB programmes in varied programmatic settings.
耐多药结核病（MDR-TB）和广泛耐药结核病（XDR-TB）患者的治疗选择有限。贝达喹啉、德拉马尼和利奈唑胺方案（BPaL）是一种新的治疗方案，六个月后显示出良好的疗效。本研究在南非、格鲁吉亚和菲律宾三个不同的流行病学环境下，对 BPaL 与 XDR-TB 标准治疗方案进行了成本效果分析。
采用马尔可夫队列模型进行成本效果分析。
南非、格鲁吉亚和菲律宾。
XDR-TB 和 MDR-TB 失败及不耐受患者。
BPaL 方案。
（1）采用 BPaL 治疗方案对比全球基金药物定价的标准治疗方案，每避免一个伤残调整生命年（DALY）所增加的成本。（2）BPaL 方案达到成本中性的潜在最高价格。
在全球基金药物定价下，贝达喹啉治疗 XDR-TB 可能在所有研究地点都具有成本效益。这些节省的幅度取决于国家的 XDR-TB 流行率，在南非、格鲁吉亚和菲律宾，5 年内，BPaL 方案可节省约 300 万美元、20 万美元和 6 万美元。在南非，由于 BPaL 治疗后更多患者存活，随之而来的抗逆转录病毒治疗（ART）相关未来费用降低了预计节省的幅度，约为 100 万美元。总体而言，当 BPaL 方案推广到更多人群，包括 MDR-TB 治疗失败和不耐受患者时，我们观察到节省成本和临床获益的增加。当包括 ART 费用时，BPaL 方案引入的成本效益转折点价格在格鲁吉亚和菲律宾（分别为 3650 美元和 3800 美元）高于南非（500 美元）。
本研究结果估计，BPaL 可作为当地结核病规划中一种具有成本效益的补充方案。
