Budgetary impact of using BPaL for treating extensively drug-resistant tuberculosis

Abstract

IntroductionBedaquiline, pretomanid and linezolid (BPaL) is a new all oral, 6-month regimen comprised of bedaquiline, the new drug pretomanid and linezolid, endorsed by the WHO for use under operational research conditions in patients with extensively drug-resistant tuberculosis (XDR-TB). We quantified per-patient treatment costs and the 5-year budgetary impact of introducing BPaL in Indonesia, Kyrgyzstan and Nigeria.MethodsPer-patient treatment cost of BPaL regimen was compared head-to-head with the conventional XDR-TB treatment regimen for respective countries based on cost estimates primarily assessed using microcosting method and expected frequency of each TB service. The 5-year budget impact of gradual introduction of BPaL against the status quo was assessed using a Markov model that represented patient’s treatment management and outcome pathways.ResultsThe cost per patient completing treatment with BPaL was US$7142 in Indonesia, US$4782 in Kyrgyzstan and US$7152 in Nigeria – 57%, 78% and 68% lower than the conventional regimens in the respective countries. A gradual adoption of the BPaL regimen over 5 years would result in an 5-year average national TB service budget reduction of 17% (US$128 780) in XDR-TB treatment-related expenditure in Indonesia, 15% (US$700 247) in Kyrgyzstan and 32% (US$1 543 047) in Nigeria.ConclusionOur study demonstrates that the BPaL regimen can be highly cost-saving compared with the conventional regimens to treat patients with XDR-TB in high drug-resistant TB burden settings. This supports the rapid adoption of the BPaL regimen to address the significant programmatic and clinical challenges in managing patients with XDR-TB in high DR-TB burden countries.

Cost-effectiveness of short, oral treatment regimens for rifampicin resistant tuberculosis

“…In South Africa, Georgia and Philippines, BPaL was found to be cost-saving for this population; these results were sensitive to drugs prices and assumptions around loss to follow-up [29]. In Indonesia, Kyrgyzstan, and Nigeria, adoption of the BPaL regimen was estimated to lead to a reduction in XDR-related spending between 15-32% of current expenditure [28]. Our findings support these broad conclusions that BPaL-based regimens are cost-saving and adds evidence for patients who have TB strains that are resistant rifampicin but susceptible to fluoroquinolones.…”

“…This is the first paper to evaluate the cost-effectiveness of replacing the current standard of care with BPaL-based regimens for RR-TB patients with and without fluoroquinolone resistance. Two previously published modelling analyses evaluated the cost-effectiveness and budgetary impact of BPaL for patients with pre-XDR TB and treatment-intolerant or nonresponsive MDR-TB using data from the Nix trial [28,29]. In South Africa, Georgia and Philippines, BPaL was found to be cost-saving for this population; these results were sensitive to drugs prices and assumptions around loss to follow-up [29].…”

Cost-effectiveness of short, oral treatment regimens for rifampicin resistant tuberculosis

“…This is the first paper to evaluate the cost-effectiveness of replacing the current standard of care with BPaL-based regimens for RR-TB patients with and without fluoroquinolone resistance. Two previously published modelling analyses evaluated the cost-effectiveness and budgetary impact of BPaL for patients with pre-XDR TB and treatment-intolerant or non-responsive MDR-TB using data from the Nix trial (28,29). In South Africa, Georgia and Philippines, BPaL was found to be cost-saving for this population; these results were sensitive to drugs prices and assumptions around loss to follow-up (29).…”

Lifesaving, cost-saving: Innovative simplified regimens for drug-resistant tuberculosis

“…When using BPaLM/BPaL regimens, the potential savings can be estimated at ~40% compared to STR (~$1,000-$2,000 savings per patient) and ~75% compared to LTR ($4,000-$6,000 savings per patient) [8]. Several other publications modelling costs of treatment for people with MDR-TB and pre-XDR, or who are MDR-TB treatment intolerant or nonresponsive, estimate the savings on using BPaL would range between 80% to 90% (up to $12,000 per patient) [9,10]. These significant savings would primarily result from the shortened duration of treatment and the resulting lower healthcare costs, including fewer monthly follow-ups and a reduced need for lab-based treatment monitoring.…”