Cost-Effectiveness of Bedaquiline for the Treatment of Multidrug-Resistant Tuberculosis in the Republic of Korea

• Published in: Clinical therapeutics 2016-03, Vol.38 (3), p.655-667.e2
• Main Authors: Park, Hae-Young, MS, Ku, Hye-min, MS, Sohn, Hyun-Soon, PhD, Seo, Hae-Sook, MD, PhD, Yung Lee, Hyun, MS, Hwa Lim, Kyung, PhD, Kwon, Jin-Won, PhD
• Format: Article
• Language: English
• Subjects: bedaquiline; Clinical medicine; Cost analysis; Cost-Benefit Analysis; cost-effectiveness; Diarylquinolines - economics; Diarylquinolines - therapeutic use; Drug dosages; Drug resistance; Humans; Internal Medicine; Medical Education; Mortality; Multidrug resistant organisms; multidrug-resistant tuberculosis; Mycobacterium; Quality-Adjusted Life Years; Republic of Korea; Sensitivity analysis; Studies; Success; Tuberculosis; Tuberculosis, Multidrug-Resistant - drug therapy; Tuberculosis, Multidrug-Resistant - economics
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2016.01.023

Abstract Purpose Bedaquiline is a new drug used for the treatment of multidrug-resistant tuberculosis (MDR-TB). This study aimed to evaluate the cost-effectiveness of adding bedaquiline to a standard regimen (SR) for treating patients with MDR-TB, including extensively drug-resistant (XDR)-TB, in the Republic of Korea. Methods A cohort-based decision-analytic model developed in a previously published study from the United Kingdom was used, with a 20-year time horizon and a 5% discount rate for cost and effectiveness, to evaluate the incremental cost-effectiveness ratios of bedaquiline + SR and SR only. The key parameters regarding the clinical data were available via the published Phase II trial of bedaquiline. Additional parameters for recurrence, cure status, loss to follow-up, surgery, death, cost, and health utility were based on Korean data if available; otherwise the international literature data were applied. Univariate and probabilistic sensitivity analyses were conducted. Findings Based on the analysis, a patient on bedaquiline + SR would gain 1.20 quality-adjusted life-years (QALYs) at 13,961,659 Korean won (KRW) (1100 KRW = US $1) of additional cost compared with a patient administered SR only, with an incremental cost/utility ratio of 11,638,656 KRW/QALY. Bedaquiline + SR had an 80% probability of being cost-effective, at a willingness-to-pay threshold of 26 million KRW, compared with SR only. Implications The results of this study suggest that, in the Republic of Korea, bedaquiline, as a part of combination therapy with SR, is a cost-effective option for the treatment of MDR-TB (including XDR-TB) compared with SR only.