Economic aspects of using new chemotherapy regimens for multidrug and extensively drugresistant tuberculosis

Abstract

Objective: to systematize data on cost-effectiveness evaluation of new multidrug and extensively drug-resistant tuberculosis (MDR/XDR-TB) chemotherapy regimens.Material and methods. An analysis of 19 publications devoted to the economic evaluation of the treatment of active MDR/XDR-TB was carried out. The literature search was performed in the electronic databases PubMed/MEDLINE, Google Scholar, eLibrary for the period from January 2015 to February 2022 inclusively.Results. Economic efficiency was studied in high-, middleand low-income countries. All publications contained calculation of treatment costs, and a third of the studies also estimated additional costs. Bedaquiline, delamanid, and pretomanid regimens were included in treatment alone or compared with a background regimen. The most commonly used economic model was the Markov one. To compare primary outcomes, most studies assessed disabilityand quality-adjusted life years. The overall cost of MDR/XDR-TB treatment varied by country income level. In all cases, bedaquiline-based regimens represented a cost-effective alternative to previous treatment, showed high efficacy in MDR/XDR-TB therapy, and were more cost-effective than delamanid regimens.Conclusion. Cost-effective interventions for active MDR/XDR-TB therapy should include the introduction of new chemotherapy regimens, reduced hospital stays and decentralized treatment, which is especially relevant in countries with high tuberculosis burden.

Keywords

• cost-effectiveness analysis
• economic evaluation
• tuberculosis
• multidrug resistance
• extensively drug resistance
• new anti-tuberculosis drugs