Cost-effectiveness of BPaL/BPaLM as compared to mixed standard of care bedaquiline containing regimen for MDR/RR-TB.

Background & objectives Current options for treating tuberculosis (TB) that is resistant to rifampicin (RR-TB) are limited and available regimens are often lengthy and poorly tolerated. However, following recent evidence from the TB PRACTECAL trial, countries are considering programmatic adoption of six-month, all-oral treatment regimen such as bedaquiline, pretomanid, linezolid (BPaL) and BPaL with moxifloxacin (BPaLM). We conducted an economic evaluation to assess whether the introduction of BPaL/BPaLM regimen under National Tuberculosis Elimination Programme (NTEP) for the treatment of multi-drug resistant (MDR)/RR-TB is a cost-effective strategy. The idea was to estimate the incremental cost incurred from BPaL/BPaLM regimen in comparison with the current mix of standard of care (SoC) regimen. Methods We used an economic model comprising a Markov analysis. The study estimated the incremental costs, life years gained and quality adjusted life years (QALYs) gained by the introduction of BPaL/BPaLM regimen for MDR/RR-TB patients. A scenario analysis for different proportions of shorter and longer SoC regimen compared with BPaL/BPaLM was also done. Cost threshold analysis was done to assess the ideal cost at which the drug BPaL/BPaLM turns into cost-saving. Budget impact analysis was conducted to assess the financial implications of adopting BPaL/BPaLM compared to mix SoC, supporting informed decision-making alongside cost-effectiveness analysis for one year. Results The base case analysis showed the total discounted costs by health system perspective for the BPaL, BPaLM and the current mixed SoC were INR 2515, INR 2644 and INR 2630 million, respectively. The ICER for BPaL was INR -379 which indicates that we have to spend INR 379 less per patient for BPaL than the mixed SoC to gain one QALY. The ICER for BPaLM was INR 37 which indicates that we have to spend INR 37 additionally per patient for BPaLM than the mixed SoC to gain one QALY. Interpretation & conclusions Our findings indicate that BPaL based regimens are likely to be cost-saving and more effective than the current mixed SoC in a range of settings. Countries should consider programmatic uptake of BPaL based regimens to treat MDR/RR-TB.