Ana-Maria Ionescu1, Abela Mpobela Agnarson1, Chrispin Kambili2, Laurent Metz3, Jonathan Kfoury4, Steven Wang5, Abeda Williams6, Vikram Singh7, Adrian Thomas1. 1. a Johnson & Johnson Global Public Health , New Brunswick , NJ , USA. 2. b Johnson & Johnson Global Public Health , South Raritan , NJ , USA. 3. c Johnson & Johnson Global Public Health , Asia Pacific , Singapore. 4. d L.E.K. Consulting , San Francisco , CA , USA. 5. e L.E.K. Consulting , Boston , MA , USA. 6. f Pharmaceutical Division of Johnson and Johnson , Janssen Pharmaceutica South Africa , Johannesburg , South Africa. 7. g Janssen India, Pharmaceutical Division of Johnson and Johnson Pvt. Ltd ., India.
Abstract
BACKGROUND: Drug-resistant tuberculosis (DR-TB) continues to be a major public health challenge with suboptimal treatment outcomes including well-documented treatment-related toxicities. We compared the cost-effectiveness of bedaquiline (BDQ) containing regimens with injectable containing regimens (short-course regimen [SCR] and long-course regiman [LCR]) in India, Russia, and South Africa. METHODS: The analysis evaluated the direct costs of DR-TB treatment which included drugs, hospitalization, injectable-related adverse event costs, and other costs. Scenarios altered regimen costs, SCR/LCR ratio, and substitution rate between regimens (whether BDQ or injectable containing). RESULTS: BDQ containing regimens are more cost effective based on cost per treatment success compared with injectable containing regimens, reducing these in SCR by 18-20% and in LCR by 49-54%. Average cost effectiveness ratios (ACERs) of BDQ containing regimens are lower. The incremental cost effectiveness ratio (ICER) is negative. Exclusive use of BDQ containing regimens results in approximately 61,000 more patients treated successfully over 5 years. CONCLUSIONS: Across all countries, BDQ containing regimens are dominant compared to injectable containing regimens, entailing lower treatment costs to achieve better clinical outcomes. This analysis can provide insight and support to local and global decision-makers and public health organizations to allocate efficiently resources improving patient and public health outcomes.
BACKGROUND:Drug-resistant tuberculosis (DR-TB) continues to be a major public health challenge with suboptimal treatment outcomes including well-documented treatment-related toxicities. We compared the cost-effectiveness of bedaquiline (BDQ) containing regimens with injectable containing regimens (short-course regimen [SCR] and long-course regiman [LCR]) in India, Russia, and South Africa. METHODS: The analysis evaluated the direct costs of DR-TB treatment which included drugs, hospitalization, injectable-related adverse event costs, and other costs. Scenarios altered regimen costs, SCR/LCR ratio, and substitution rate between regimens (whether BDQ or injectable containing). RESULTS:BDQ containing regimens are more cost effective based on cost per treatment success compared with injectable containing regimens, reducing these in SCR by 18-20% and in LCR by 49-54%. Average cost effectiveness ratios (ACERs) of BDQ containing regimens are lower. The incremental cost effectiveness ratio (ICER) is negative. Exclusive use of BDQ containing regimens results in approximately 61,000 more patients treated successfully over 5 years. CONCLUSIONS: Across all countries, BDQ containing regimens are dominant compared to injectable containing regimens, entailing lower treatment costs to achieve better clinical outcomes. This analysis can provide insight and support to local and global decision-makers and public health organizations to allocate efficiently resources improving patient and public health outcomes.
Authors: Gilbert Lazarus; Kevin Tjoa; Anthony William Brian Iskandar; Melva Louisa; Evans L Sagwa; Nesri Padayatchi; Vivian Soetikno Journal: PLoS One Date: 2021-03-04 Impact factor: 3.240