Masuku S D, Nattey C, Coetzee L, Hirasen K, Mabhula A, Casalme D J, Gler M T, Gupta A, Juneja S, Ndjeka N, Evans D, Nichols B E
Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
SCHARR, Sheffield Centre for Health and Related Research, Division of Population Health, School of Medicine and Population Health, University of Sheffield, Sheffield, UK.
IJTLD Open. 2025 Sep 10;2(9):535-541. doi: 10.5588/ijtldopen.25.0294. eCollection 2025 Sep.
The WHO endorses bedaquiline, pretomanid, and linezolid (BPaL)-based regimens for multidrug-resistant/rifampicin-resistant TB, and both the Philippines (PH) and South Africa (SA) have adopted these regimens.
Using a Markov model, we assessed the cost per successful treatment and 5-year budgetary and economic impact of BPaL-based regimens in SA and PH. Treatment outcomes were informed by national electronic registries, SA BPaL Clinical Access Program, and PH operational research. Costs were estimated from the provider perspective.
Over 5 years, BPaL-based regimens reduce total costs by 20%-25% in SA and 9%-11% in PH compared with a standard short oral regimen (SSOR) when achieving the same number of successful treatments, due to lower cost per successful treatment from reduced loss to follow-up and mortality. BPaL-based regimens improve treatment success by 22%, leading to more patients completing full treatment and higher overall resource use. Therefore, the budget for BPaL-based regimens is projected to increase by 7%-8% (SA) and 6% (PH) from 2023/24 to 2027/28.
BPaL-based regimens reduce cost per successful treatment compared with SSOR and require smaller budgets for similar treatment outcomes. Implementation may involve initial budget increases, but improvements in treatment success and long-term health outcomes outweigh these costs, presenting a strong rationale for rollout.
世界卫生组织认可以贝达喹啉、普瑞玛尼和利奈唑胺（BPaL）为基础的方案用于耐多药/利福平耐药结核病治疗，菲律宾（PH）和南非（SA）均已采用这些方案。
我们使用马尔可夫模型评估了在南非和菲律宾以BPaL为基础的方案每成功治疗一例的成本以及5年预算和经济影响。治疗结果参考了国家电子登记系统、南非BPaL临床准入计划和菲律宾的运营研究。成本是从提供者的角度进行估算的。
在5年期间，与标准短程口服方案（SSOR）相比，当成功治疗的病例数相同时，以BPaL为基础的方案在南非可使总成本降低20%-25%，在菲律宾降低9%-11%，这是因为因失访和死亡率降低，每成功治疗一例的成本较低。以BPaL为基础的方案使治疗成功率提高了22%，从而使更多患者完成全程治疗，总体资源使用增加。因此，预计从2023/24年到2027/28年，以BPaL为基础的方案预算在南非将增加7%-8%，在菲律宾将增加6%。
与SSOR相比，以BPaL为基础的方案降低了每成功治疗一例的成本，且在获得相似治疗结果时所需预算较少。实施该方案可能最初会增加预算，但治疗成功率的提高和长期健康结果超过了这些成本，这为推广该方案提供了有力的理由。
