National Center for Tuberculosis Control and Prevention, China CDC, Beijing 100226, China.
China National Health Development Research Center, Beijing 100226, China;The University of Sheffield, S10 2TN, Sheffield, The United Kingdom.
Biomed Environ Sci. 2023 Jun 20;36(6):501-509. doi: 10.3967/bes2023.061.
This study aims to estimate the cost-effectiveness of the combined chemotherapy regimen containing Bedaquiline (BR) and the conventional treatment regimen (CR, not containing Bedaquiline) for the treatment of adults with multidrug-resistant tuberculosis (MDR-TB) in China.
A combination of a decision tree and a Markov model was developed to estimate the cost and effects of MDR patients in BR and CR within ten years. The model parameter data were synthesized from the literature, the national TB surveillance information system, and consultation with experts. The incremental cost-effectiveness ratio (ICER) of BR . CR was determined.
BR ( . CR) had a higher sputum culture conversion rate and cure rate and prevented many premature deaths (decreased by 12.8%), thereby obtaining more quality-adjusted life years (QALYs) (increased by 2.31 years). The per capita cost in BR was as high as 138,000 yuan, roughly double that of CR. The ICER for BR was 33,700 yuan/QALY, which was lower than China's 1× per capita Gross Domestic Product (GDP) in 2020 (72,400 yuan).
BR is shown to be cost effective. When the unit price of Bedaquiline reaches or falls below 57.21 yuan per unit, BR is expected to be the dominant strategy in China over CR.
本研究旨在评估贝达喹啉（BR）联合化疗方案与不包含贝达喹啉的常规治疗方案（CR）治疗中国成人耐多药结核病（MDR-TB）的成本效益。
采用决策树和马尔可夫模型相结合的方法，估算 BR 和 CR 治疗方案下 MDR 患者十年内的成本和效果。模型参数数据综合了文献、全国结核病监测信息系统和专家咨询结果。BR 与 CR 的增量成本效益比（ICER）。
BR（CR）具有更高的痰培养转化率和治愈率，预防了许多过早死亡（减少 12.8%），从而获得了更多的质量调整生命年（增加 2.31 年）。BR 的人均成本高达 13.8 万元，是 CR 的两倍左右。BR 的 ICER 为 33700 元/QALY，低于中国 2020 年人均国内生产总值（GDP）的 1 倍（72400 元）。
BR 具有成本效益。当贝达喹啉的单价达到或低于 57.21 元/单位时，BR 有望成为中国比 CR 更具优势的治疗策略。
