Cost-effectiveness of bedaquiline, pretomanid and linezolid for treatment of extensively drug-resistant tuberculosis in South Africa, Georgia and the Philippines.
Gabriela Beatriz Gomez, Mariana Siapka, Francesca Conradie, Norbert Ndjeka, Anna Marie Celina Garfin, Nino Lomtadze, Zaza Avaliani, Nana Kiria, Shelly Malhotra, Sarah Cook-Scalise, Sandeep Juneja, Daniel Everitt, Melvin Spigelman, Anna Vassall
Author Information
Gabriela Beatriz Gomez: Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK gabriela.gomez@lshtm.ac.uk. ORCID
Mariana Siapka: Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Francesca Conradie: Clinical HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
Norbert Ndjeka: National TB Programme, South Africa Department of Health, Pretoria, Gauteng, South Africa. ORCID
Anna Marie Celina Garfin: National Tuberculosis Control Program, Bureau of Disease Prevention and Control, Department of Health, Manila, The Philippines.
Nino Lomtadze: Department of TB Surveillance and Strategic Planning, National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia.
Zaza Avaliani: Department of TB Surveillance and Strategic Planning, National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia.
Nana Kiria: Department of TB Surveillance and Strategic Planning, National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia.
Shelly Malhotra: TB Alliance, New York, New York, USA.
Sarah Cook-Scalise: TB Alliance, New York, New York, USA.
Sandeep Juneja: TB Alliance, New York, New York, USA.
Daniel Everitt: TB Alliance, New York, New York, USA.
Melvin Spigelman: TB Alliance, New York, New York, USA.
Anna Vassall: Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
OBJECTIVES: Patients with highly resistant tuberculosis have few treatment options. Bedaquiline, pretomanid and linezolid regimen (BPaL) is a new regimen shown to have favourable outcomes after six months. We present an economic evaluation of introducing BPaL against the extensively drug-resistant tuberculosis (XDR-TB) standard of care in three epidemiological settings. DESIGN: Cost-effectiveness analysis using Markov cohort model. SETTING: South Africa, Georgia and the Philippines. PARTICIPANTS: XDR-TB and multidrug-resistant tuberculosis (MDR-TB) failure and treatment intolerant patients. INTERVENTIONS: BPaL regimen. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Incremental cost per disability-adjusted life years averted by using BPaL against standard of care at the Global Drug Facility list price. (2) The potential maximum price at which the BPaL regimen could become cost neutral. RESULTS: BPaL for XDR-TB is likely to be cost saving in all study settings when pretomanid is priced at the Global Drug Facility list price. The magnitude of these savings depends on the prevalence of XDR-TB in the country and can amount, over 5 years, to approximately US$ 3 million in South Africa, US$ 200 000 and US$ 60 000 in Georgia and the Philippines, respectively. In South Africa, related future costs of antiretroviral treatment (ART) due to survival of more patients following treatment with BPaL reduced the magnitude of expected savings to approximately US$ 1 million. Overall, when BPaL is introduced to a wider population, including MDR-TB treatment failure and treatment intolerant, we observe increased savings and clinical benefits. The potential threshold price at which the probability of the introduction of BPaL becoming cost neutral begins to increase is higher in Georgia and the Philippines (US$ 3650 and US$ 3800, respectively) compared with South Africa (US$ 500) including ART costs. CONCLUSIONS: Our results estimate that BPaL can be a cost-saving addition to the local TB programmes in varied programmatic settings.
