Journal Article

Budgetary impact of using BPaL for treating extensively drug-resistant tuberculosis

Lawanson, Adebola, Gebhard, Agnes, Pambudi, Imran, Sugiharto, Jhon, Useni, Sani, Sohn, Hojoon, Edo, Patience, Mulder, Christiaan, Kadyrov, Abdullaat, Rupert, Stephan, van den Hof, Susan, Cook-Scalise, Sarah, Setiawan, Ery, Mambetova, Elmira, Juneja, Sandeep, Malhotra, Shelly

2022

Overview

IntroductionBedaquiline, pretomanid and linezolid (BPaL) is a new all oral, 6-month regimen comprised of bedaquiline, the new drug pretomanid and linezolid, endorsed by the WHO for use under operational research conditions in patients with extensively drug-resistant tuberculosis (XDR-TB). We quantified per-patient treatment costs and the 5-year budgetary impact of introducing BPaL in Indonesia, Kyrgyzstan and Nigeria.MethodsPer-patient treatment cost of BPaL regimen was compared head-to-head with the conventional XDR-TB treatment regimen for respective countries based on cost estimates primarily assessed using microcosting method and expected frequency of each TB service. The 5-year budget impact of gradual introduction of BPaL against the status quo was assessed using a Markov model that represented patient’s treatment management and outcome pathways.ResultsThe cost per patient completing treatment with BPaL was US$7142 in Indonesia, US$4782 in Kyrgyzstan and US$7152 in Nigeria – 57%, 78% and 68% lower than the conventional regimens in the respective countries. A gradual adoption of the BPaL regimen over 5 years would result in an 5-year average national TB service budget reduction of 17% (US$128 780) in XDR-TB treatment-related expenditure in Indonesia, 15% (US$700 247) in Kyrgyzstan and 32% (US$1 543 047) in Nigeria.ConclusionOur study demonstrates that the BPaL regimen can be highly cost-saving compared with the conventional regimens to treat patients with XDR-TB in high drug-resistant TB burden settings. This supports the rapid adoption of the BPaL regimen to address the significant programmatic and clinical challenges in managing patients with XDR-TB in high DR-TB burden countries.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Antitubercular Agents - therapeutic use / Capital costs / Clinical outcomes / Clinical trials / Cost analysis / Cost estimates / Diarylquinolines / Drug resistance / Extensively Drug-Resistant Tuberculosis - drug therapy / FDA approval / health economics / Health services / HIV / Human immunodeficiency virus / Humans / Linezolid - therapeutic use / Markov chains / Nitroimidazoles / Operations research / Oral administration / Original Research / Patients / Regulatory approval / treatment / Tuberculosis