Evans D, Hirasen K, Casalme D J, Gler M T, Gupta A, Juneja S
Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
Health Economics Division, Faculty of Health Sciences, School of Public Health, University of Cape Town, Cape Town, South Africa.
IJTLD Open. 2024 Jun 1;1(6):242-249. doi: 10.5588/ijtldopen.24.0094. eCollection 2024 Jun.
In 2022, the WHO announced that the 6-month BPaL/M regimen should be used for drug-resistant TB (DR-TB). We estimate the patient and provider costs of BPaL compared to current standard-of-care treatment in the Philippines.
Patients on BPaL under operational research, or 9-11-month standard short oral regimen (SSOR) and 18-21-month standard long oral regimen (SLOR) under programmatic conditions were interviewed using the WHO cross-sectional TB patient cost tool. Provider costs were assessed through a bottom-up and top-down costing analysis.
Total patient costs per treatment episode were lowest with BPaL (USD518.0) and increased with use of SSOR (USD825.8) and SLOR (USD1,023.0). Total provider costs per successful treatment were lowest with BPaL (USD1,994.5) and increased with SSOR (USD3,121.5) and SLOR (USD10,032.4). Compared to SSOR, BPaL treatment was cost-effective at even the lowest willingness to pay threshold. As expected, SLOR was the costliest and least effective regimen.
Costs incurred by patients on BPaL were 37% (95% CI 22-56) less than SSOR and 50% (95% CI 32-68) less than SLOR, while providers could save 36% (95% CI 21-56) to 80% (95% CI 64-93) per successful treatment, respectively. The study shows that treatment of DR-TB with BPaL was cost-saving for patients and cost-effective for the health system.
2022年，世界卫生组织宣布，6个月的BPaL/M方案应用于耐多药结核病（DR-TB）治疗。我们评估了在菲律宾，相较于当前的标准治疗方案，BPaL方案治疗耐多药结核病的患者成本和医疗服务提供者成本。
采用世界卫生组织横断面结核病患者成本工具，对参与运营研究的接受BPaL方案治疗的患者，以及在项目条件下接受9 - 11个月标准短程口服方案（SSOR）和18 - 21个月标准长程口服方案（SLOR）治疗的患者进行访谈。通过自下而上和自上而下的成本分析评估医疗服务提供者成本。
每个治疗疗程的患者总成本以BPaL方案最低（518.0美元），使用SSOR方案（825.8美元）和SLOR方案（1023.0美元）时成本增加。每例成功治疗的医疗服务提供者总成本以BPaL方案最低（1994.5美元），使用SSOR方案（3121.5美元）和SLOR方案（10032.4美元）时成本增加。与SSOR方案相比，即使在最低支付意愿阈值下，BPaL方案治疗仍具有成本效益。正如预期的那样，SLOR方案是成本最高且效果最差的治疗方案。
接受BPaL方案治疗的患者成本比接受SSOR方案治疗的患者低37%（95%置信区间22 - 56），比接受SLOR方案治疗的患者低50%（95%置信区间32 - 68），而医疗服务提供者每例成功治疗可分别节省36%（95%置信区间21 - 56）至80%（95%置信区间64 - 93）。该研究表明，使用BPaL方案治疗耐多药结核病对患者而言可节省成本，对卫生系统而言具有成本效益。
