title: Cost-effectiveness of adding bedaquiline to drug regimens for the treatment of multidrug-resistant tuberculosis in the UK.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of adding bedaquiline to a background regimen (BR) of drugs for multidrug-resistant tuberculosis (MDR-TB) in the United Kingdom (UK).
  
  
  METHODS
  A cohort-based Markov model was developed to estimate the incremental cost-effectiveness ratio of bedaquiline plus BR (BBR) versus BR alone (BR) in the treatment of MDR-TB, over a 10-year time horizon. A National Health Service (NHS) and personal social services perspective was considered. Cost-effectiveness was evaluated in terms of Quality-Adjusted Life Years (QALYs) and Disability-Adjusted Life Years (DALYs). Data were sourced from a phase II, placebo-controlled trial, NHS reference costs, and the literature; the US list price of bedaquiline was used and converted to pounds (£18,800). Costs and effectiveness were discounted at a rate of 3.5% per annum. Probabilistic and deterministic sensitivity analysis was conducted.
  
  
  RESULTS
  The total discounted cost per patient (pp) on BBR was £106,487, compared with £117,922 for BR. The total discounted QALYs pp were 5.16 for BBR and 4.01 for BR. The addition of bedaquiline to a BR resulted in a cost-saving of £11,434 and an additional 1.14 QALYs pp over a 10-year period, and is therefore considered to be the dominant (less costly and more effective) strategy over BR. BBR remained dominant in the majority of sensitivity analyses, with a 81% probability of being dominant versus BR in the probabilistic analysis.
  
  
  CONCLUSIONS
  In the UK, bedaquiline is likely to be cost-effective and cost-saving, compared with the current MDR-TB standard of care under a range of scenarios. Cost-savings over a 10-year period were realized from reductions in length of hospitalization, which offset the bedaquiline drug costs. The cost-benefit conclusions held after several sensitivity analyses, thus validating assumptions made, and suggesting that the results would hold even if the actual price of bedaquiline in the UK were higher than in the US.
authors: Janssen Pharmaceutica NV, Beerse, Belgium.
authors: Lara J
authors: LJ
authors: Wolfson
authors: HERON Commercialization, London, United Kingdom.
authors: Anna
authors: A
authors: Walker
authors: HERON Commercialization, London, United Kingdom.
authors: Robert
authors: R
authors: Hettle
authors: Janssen Pharmaceutica NV, Beerse, Belgium.
authors: Xiaoyan
authors: X
authors: Lu
authors: Janssen Global Services LLC, Raritan, New Jersey, United States of America.
authors: Chrispin
authors: C
authors: Kambili
authors: Janssen (Janssen-Cilag), High Wycombe, United Kingdom.
authors: Andrew
authors: A
authors: Murungi
authors: Janssen (Janssen-Cilag), High Wycombe, United Kingdom.
authors: Gerhart
authors: G
authors: Knerer
mesh_terms: D000995:Antitubercular Agents / Q000191:economics* / Q000494:pharmacology / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D064687:Diarylquinolines / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D008390:Markov Chains; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000191:economics*; D035501:Uncertainty; D006113:United Kingdom
chemical_list: D000995:Antitubercular Agents; D064687:Diarylquinolines; C493870:bedaquiline