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

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

Int J Infect Dis. 2018 Oct 17;:

Authors: Fan Q, Ming WK, Yip WY, You JHS

Abstract
OBJECTIVE: Hong Kong is a high-income city of China with intermediate tuberculosis (TB) burden and 1% of TB cases were multidrug-resistant tuberculosis (MDR-TB). We aimed to examine the potential cost-effectiveness of adding bedaquiline or delamanid to background regimen (BR) for treatment of MDR-TB in Hong Kong.
METHODS: A decision-analytic model was designed to simulate outcomes, over a 10-year time horizon, of 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 base-case analysis, BR was the least costly regimen (USD47,396) with the lowest QALY gained (6.347). Comparing to BR, B-BR gained additional 0.731 QALYs with incremental cost of USD9. ICER of B-BR was 12 USD/QALY. D-BR was more costly than BR by USD20,164 and gained additional 0.012 QALYs. ICER of D-BR was 1,680,333 USD/QALY. In probabilistic sensitivity analysis with 10,000 Monte Carlo simulations, B-BR and D-BR were cost-effective in 99.98% and 5.13% of time, respectively, using 1×GDP per capita (USD46,182) as willingness-to-pay threshold.
CONCLUSIONS: Bedaquiline is more likely than delamanid to be cost-effective when added to BR for treatment of MDR-TB in Hong Kong.

PMID: 30342251 [PubMed - as supplied by publisher]