Cost-effectiveness of bedaquiline or delamanid plus background regimen for multidrug-resistant tuberculosis in a high-income intermediate burden city of China

Abstract

Objective: Hong Kong is a high-income city of China with an intermediate tuberculosis (TB) burden, and 1% of TB cases are multidrug-resistant (MDR-TB). The aim of this study was to examine the potential costeffectiveness of adding bedaquiline or delamanid to the background regimen (BR) for the treatment of MDR-TB in Hong Kong. Methods: A decision-analytic model was designed to simulate outcomes over a 10-year time horizon for MDR-TB patients treated with bedaquiline plus BR (B-BR), delamanid plus BR (D-BR), or BR alone. Outcome measures included direct medical costs and quality-adjusted life-years (QALYs) gained. Results: In the base-case analysis, BR was the least costly regimen (USD 47 396) with the lowest QALYs gained (6.347). Compared to BR, B-BR gained an additional 0.731 QALYs with incremental cost of USD 9. The incremental cost-effectiveness ratio (ICER) of B-BR was USD 12/QALY. D-BR was more costly than BR by USD 20 164 and gained an additional 0.012 QALYs. The ICER of D-BR was USD 1 680 333/QALY. In the probabilistic sensitivity analysis with 10 000 Monte Carlo simulations, B-BR and D-BR were cost-effective 99.98% and 5.13% of the time, respectively, using 1Â gross domestic product per capita (USD 46 182) as the willingness-to-pay threshold. Conclusions: Bedaquiline is more likely than delamanid to be cost-effective when added to BR for the treatment of MDR-TB in Hong Kong.

A Systematic Review of Economic Evaluations of Active Tuberculosis Treatments

“…In terms of the study population, 7 studies ( Hunchangsith et al, 2012 ; Manabe et al, 2012 ; Owens et al, 2013 ; Law et al, 2014 ; Knight et al, 2015 ; Gomez et al, 2016 ; Nsengiyumva et al, 2018 ) were conducted with drug-susceptible or treatment-naïve TB (hereafter treatment-naïve TB) patients who initiated TB treatment for the first time. Eleven studies were conducted with MDR-TB patients ( Wolfson et al, 2015 ; Park et al, 2016 ; Codecasa et al, 2017 ; Lu et al, 2017 ; Wirth et al, 2017 ; Schnippel et al, 2018a ; Schnippel et al, 2018b ; John et al, 2018 ; Loveday et al, 2018 ; Nsengiyumva et al, 2018 ; Fan et al, 2019 ). Nsengiyumva et al (2018) conducted a study with treatment-naïve and MDR-TB patients using two distinct models and included latent TB patients.…”

“… Nsengiyumva et al (2018) conducted a study with treatment-naïve and MDR-TB patients using two distinct models and included latent TB patients. Six out of 8 studies which were conducted in HICs were dealing with MDR-TB patients ( Wolfson et al, 2015 ; Park et al, 2016 ; Codecasa et al, 2017 ; Lu et al, 2017 ; Wirth et al, 2017 ; Fan et al, 2019 ), whereas studies from LMICs were relatively balanced with MDR-TB (6 studies) ( Lu et al, 2017 ; Schnippel et al, 2018a ; Schnippel et al, 2018b ; John et al, 2018 ; Loveday et al, 2018 ; Nsengiyumva et al, 2018 ) and treatment-naïve TB (5 studies) ( Hunchangsith et al, 2012 ; Manabe et al, 2012 ; Knight et al, 2015 ; Gomez et al, 2016 ; Nsengiyumva et al, 2018 ).…”

“…In terms of intervention types, most of the selected articles (13 out of 17) examined interventions of medications, comparing the standard 6-month regimen with longer (8-month) ( Manabe et al, 2012 ) or shorter regimens (2 or 4 months) ( Owens et al, 2013 ; Knight et al, 2015 ; Gomez et al, 2016 ) in treatment-naïve TB patients, or compared background regimens with new regimens that contain new drugs, such as bedaquiline, in MDR-TB patients ( Wolfson et al, 2015 ; Park et al, 2016 ; Codecasa et al, 2017 ; Lu et al, 2017 ; Wirth et al, 2017 ; Schnippel et al, 2018a ; Schnippel et al, 2018b ; Fan et al, 2019 ). One study ( Law et al, 2014 ) compared standardized TB treatments with varying drug resistance in treatment-naïve patients with TB.…”

“…Nine out of 17 studies used a Markov model ( Law et al, 2014 ; Wolfson et al, 2015 ; Park et al, 2016 ; Codecasa et al, 2017 ; Lu et al, 2017 ; Wirth et al, 2017 ; Schnippel et al, 2018a ; Schnippel et al, 2018b ; Nsengiyumva et al, 2018 ; Fan et al, 2019 ), and 6 studies used a decision tree model ( Hunchangsith et al, 2012 ; Manabe et al, 2012 ; Owens et al, 2013 ; John et al, 2018 ; Nsengiyumva et al, 2018 ; Fan et al, 2019 ). Fan et al (2019) conducted an economic evaluation using a decision tree combined with a Markov model. Distinctively, Knight et al (2015) used a transmission model, and Gomez et al (2016) used an individual-based decision-analytic model.…”

Cost-effectiveness of bedaquiline, pretomanid and linezolid for treatment of extensively drug-resistant tuberculosis in South Africa, Georgia and the Philippines

“…To date, a series of economic evaluations looking at the addition of bedaquiline to MDR treatment regimens for the treatment of adult patients with pulmonary MDR-TB and/or XDR-TB have been published. [13][14][15][16][17][18][19][20][21][22] However, there has been no economic evaluation of a shorter, alloral treatment regimen, consisting of three drugs with minimal pre-existing resistance, such as BPaL. We present here an economic evaluation of introducing BPaL for use in XDR-TB against the local standard of care.…”