Cost-effectiveness of bedaquiline, pretomanid and linezolid for treatment of extensively drug-resistant tuberculosis in South Africa, Georgia and the Philippines
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 tu...
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BMJ Publishing Group
2021-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/12/e051521.full |
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| author | Francesca Conradie Anna Vassall Norbert Ndjeka Gabriela Beatriz Gomez Mariana Siapka Anna Marie Celina Garfin Nino Lomtadze Zaza Avaliani Nana Kiria Shelly Malhotra Sarah Cook-Scalise Sandeep Juneja Daniel Everitt Melvin Spigelman |
| author_facet | Francesca Conradie Anna Vassall Norbert Ndjeka Gabriela Beatriz Gomez Mariana Siapka Anna Marie Celina Garfin Nino Lomtadze Zaza Avaliani Nana Kiria Shelly Malhotra Sarah Cook-Scalise Sandeep Juneja Daniel Everitt Melvin Spigelman |
| author_sort | Francesca Conradie |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-34e7c4ff8d494dee9d5db81d5f531aa8 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-12-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-34e7c4ff8d494dee9d5db81d5f531aa82025-08-20T02:20:22ZengBMJ Publishing GroupBMJ Open2044-60552021-12-01111210.1136/bmjopen-2021-051521Cost-effectiveness of bedaquiline, pretomanid and linezolid for treatment of extensively drug-resistant tuberculosis in South Africa, Georgia and the PhilippinesFrancesca Conradie0Anna Vassall1Norbert Ndjeka2Gabriela Beatriz Gomez3Mariana Siapka4Anna Marie Celina Garfin5Nino Lomtadze6Zaza Avaliani7Nana Kiria8Shelly Malhotra9Sarah Cook-Scalise10Sandeep Juneja11Daniel Everitt12Melvin Spigelman134 Internal Medicine, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, Gauteng, South AfricaDepartment of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UKNational Tuberculosis Control Programme, National Department of Health, Pretoria, South AfricaDepartment of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UKImpact Epilysis, Thessaloniki, GreeceNational Tuberculosis Control Program, Bureau of Disease Prevention and Control, Department of Health, Manila, The PhilippinesDepartment of TB Surveillance and Strategic Planning, National Center for Tuberculosis and Lung Diseases, Tbilisi, GeorgiaDepartment of TB Surveillance and Strategic Planning, National Center for Tuberculosis and Lung Diseases, Tbilisi, GeorgiaDepartment of TB Surveillance and Strategic Planning, National Center for Tuberculosis and Lung Diseases, Tbilisi, GeorgiaGlobal Access, International AIDS Vaccine Initiative (IAVI), New York, New York, USAMarket Access, Global Alliance for TB Drug Development, New York, New York, USAMarket Access, Global Alliance for TB Drug Development, New York, New York, USATB Alliance, New York, New York, USATB Alliance, New York, New York, USAObjectives 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.https://bmjopen.bmj.com/content/11/12/e051521.full |
| spellingShingle | Francesca Conradie Anna Vassall Norbert Ndjeka Gabriela Beatriz Gomez Mariana Siapka Anna Marie Celina Garfin Nino Lomtadze Zaza Avaliani Nana Kiria Shelly Malhotra Sarah Cook-Scalise Sandeep Juneja Daniel Everitt Melvin Spigelman Cost-effectiveness of bedaquiline, pretomanid and linezolid for treatment of extensively drug-resistant tuberculosis in South Africa, Georgia and the Philippines BMJ Open |
| title | Cost-effectiveness of bedaquiline, pretomanid and linezolid for treatment of extensively drug-resistant tuberculosis in South Africa, Georgia and the Philippines |
| title_full | Cost-effectiveness of bedaquiline, pretomanid and linezolid for treatment of extensively drug-resistant tuberculosis in South Africa, Georgia and the Philippines |
| title_fullStr | Cost-effectiveness of bedaquiline, pretomanid and linezolid for treatment of extensively drug-resistant tuberculosis in South Africa, Georgia and the Philippines |
| title_full_unstemmed | Cost-effectiveness of bedaquiline, pretomanid and linezolid for treatment of extensively drug-resistant tuberculosis in South Africa, Georgia and the Philippines |
| title_short | Cost-effectiveness of bedaquiline, pretomanid and linezolid for treatment of extensively drug-resistant tuberculosis in South Africa, Georgia and the Philippines |
| title_sort | cost effectiveness of bedaquiline pretomanid and linezolid for treatment of extensively drug resistant tuberculosis in south africa georgia and the philippines |
| url | https://bmjopen.bmj.com/content/11/12/e051521.full |
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