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

Background: 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. Methods: 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). Results: 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. Conclusions: 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.

背景：耐药结核病（Drug-resistant tuberculosis, DR-TB）仍是全球重大公共卫生挑战，其治疗结局欠佳，且存在已被充分证实的治疗相关不良反应。本研究在印度、俄罗斯及南非三国中，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（包括短程治疗方案[SCR]和长程治疗方案[LCR]）的成本效益。方法：本分析评估了耐药结核病治疗的直接成本，涵盖药物费用、住院费用、注射剂相关不良反应治疗费用及其他相关支出。研究设置了多种情景，分别调整治疗方案成本、短程/长程方案的比例，以及两种方案（含贝达喹啉方案或含注射剂方案）间的替换率。结果：相较于含注射剂的治疗方案，含贝达喹啉的治疗方案在每例治疗成功患者的成本维度更具成本效益，可使短程方案的该类成本降低18%~20%，长程方案降低49%~54%。含贝达喹啉方案的平均成本效益比（average cost effectiveness ratios, ACERs）更低，增量成本效益比（incremental cost effectiveness ratio, ICER）为负值。若全程采用含贝达喹啉的治疗方案，5年内可多使约6.1万名患者获得治疗成功。结论：在所有研究国家中，含贝达喹啉的治疗方案均优于含注射剂的治疗方案，可在降低治疗成本的同时获得更优的临床结局。本分析可为各国及全球决策者、公共卫生机构提供参考依据，助力其高效分配卫生资源，以改善患者个体及公共卫生层面的健康结局。