Faculty of Medicine, School of Pharmacy, The Chinese University of Hong Kong, Hong Kong, SAR, China.
PLoS One. 2022 Aug 5;17(8):e0272770. doi: 10.1371/journal.pone.0272770. eCollection 2022.
The treatment success rate of conventional anti-tuberculosis (TB) regimens for extensively drug-resistant TB (XDR-TB) is low, resulting in high morbidity and healthcare cost especially in the high TB burden countries. Recent clinical findings reported improved treatment outcomes of XDR-TB with the bedaquiline (BDQ)-based regimens. We aimed to evaluate the cost-effectiveness of BDQ-based treatment for XDR-TB from the perspective of the South Africa national healthcare provider.
A 2-year decision-analytic model was designed to evaluate the clinical and economic outcomes of a hypothetical cohort of adult XDR-TB patients with (1) BDQ-based regimen and (2) injectable-based conventional regimen. The model inputs were retrieved from literature and public data. Base-case analysis and sensitivity analysis were performed. The primary model outputs included TB-related direct medical cost and disability-adjusted life years (DALYs).
In the base-case analysis, the BDQ group reduced 4.4152 DALYs with an incremental cost of USD1,606 when compared to the conventional group. The incremental cost per DALY averted (ICER) by the BDQ group was 364 USD/DALY averted. No influential factor was identified in the sensitivity analysis. In probabilistic sensitivity analysis, the BDQ group was accepted as cost-effective in 97.82% of the 10,000 simulations at a willingness-to-pay threshold of 5,656 USD/DALY averted (1× gross domestic product per capita in South Africa).
The BDQ-based therapy appeared to be cost-effective and showed a high probability to be accepted as the preferred cost-effective option for active XDR-TB treatment.
传统抗结核（TB）方案治疗广泛耐药结核病（XDR-TB）的成功率较低，导致发病率和医疗保健费用较高，尤其是在结核病负担较高的国家。最近的临床发现报告称，贝达喹啉（BDQ）为基础的方案可改善 XDR-TB 的治疗结果。我们旨在从南非国家医疗保健提供者的角度评估 BDQ 为基础的治疗方案治疗 XDR-TB 的成本效益。
设计了一个为期 2 年的决策分析模型，以评估假设的一组成人 XDR-TB 患者的临床和经济结果：（1）BDQ 为基础的方案；（2）注射用传统方案。模型输入来自文献和公共数据。进行了基础案例分析和敏感性分析。主要模型输出包括与结核病相关的直接医疗费用和残疾调整生命年（DALYs）。
在基础案例分析中，与传统组相比，BDQ 组减少了 4.4152 个 DALYs，增量成本为 1606 美元。BDQ 组每避免一个 DALY 的增量成本（ICER）为 364 美元。在敏感性分析中没有发现有影响力的因素。在概率敏感性分析中，在 5656 美元/避免一个 DALY 的意愿支付阈值（南非人均国内生产总值的 1 倍）下，BDQ 组在 10000 次模拟中的 97.82%被认为是具有成本效益的。
BDQ 为基础的治疗似乎具有成本效益，并且很有可能被接受为治疗活动性 XDR-TB 的首选具有成本效益的方案。
