Bedaquiline- versus injectable-containing drug-resistant tuberculosis regimens: a cost-effectiveness analysis

<b>Background</b>: Drug-resistant tuberculosis (DR-TB) continues to be a major public health challenge with suboptimal treatment outcomes including well-documented treatment-related toxicities. We compared the cost-effectiveness of bedaquiline (BDQ) containing regimens with injectable containing regimens (short-course regimen [SCR] and long-course regimen [LCR]) in India, Russia, and South Africa. <b>Methods</b>: The analysis evaluated the direct costs of DR-TB treatment which included drugs, hospitalization, injectable-related adverse event costs, and other costs. Scenarios altered regimen costs, SCR/LCR ratio, and substitution rate between regimens (whether BDQ or injectable containing). <b>Results</b>: BDQ containing regimens are more cost effective based on cost per treatment success compared with injectable containing regimens, reducing these in SCR by 18–20% and in LCR by 49–54%. Average cost effectiveness ratios (ACERs) of BDQ containing regimens are lower. The incremental cost effectiveness ratio (ICER) is negative. Exclusive use of BDQ containing regimens results in approximately 61,000 more patients treated successfully over 5 years. <b>Conclusions</b>: Across all countries, BDQ containing regimens are dominant compared to injectable containing regimens, entailing lower treatment costs to achieve better clinical outcomes. This analysis can provide insight and support to local and global decision-makers and public health organizations to allocate efficiently resources improving patient and public health outcomes.

<b>背景</b>：耐药结核病（Drug-resistant tuberculosis, DR-TB）仍是一项重大公共卫生挑战，其治疗结局欠佳，且存在大量已被充分记录的治疗相关不良反应。本研究对比了含贝达喹啉（bedaquiline, BDQ）的治疗方案与含注射剂的治疗方案（包括短疗程方案[short-course regimen, SCR]与长疗程方案[long-course regimen, LCR]）在印度、俄罗斯及南非的成本效益。<b>方法</b>：本分析评估了DR-TB治疗的直接成本，涵盖药品费用、住院费用、注射剂相关不良反应治疗成本及其他相关成本。各研究情景对治疗方案成本、SCR与LCR的比例以及方案间替换率（即选用含BDQ方案还是含注射剂方案的比例）进行了调整。<b>结果</b>：相较于含注射剂的治疗方案，含BDQ的方案在每例治疗成功患者的成本方面更具成本效益：在SCR中可降低18%~20%，在LCR中可降低49%~54%。含BDQ方案的平均成本效益比（Average cost effectiveness ratios, ACERs）更低，且增量成本效益比（incremental cost effectiveness ratio, ICER）为负值。若全程采用含BDQ的治疗方案，5年内可多治愈约61000名患者。<b>结论</b>：在所有研究国家中，含BDQ的治疗方案均优于含注射剂的方案，能够以更低的治疗成本获得更佳的临床结局。本分析可为各国及全球决策者、公共卫生机构提供决策参考，助力其高效配置资源，进而改善患者健康与公共卫生结局。