Managing multidrug-resistant tuberculosis in South Africa: a budget impact analysis

By  Sithabiso Daphne Masuku  Dr. Ribka Berhanu  Craig van Rensburg  N. Ndjeka,  Sydney Rosen  Lawrence Long  Denise Evans  Brooke Nichols  |  | 

S E T T ING: In South Africa prior to 2016, the standard treatment regimen formultidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB) was 24 months long and required daily injectable aminoglycoside (IA) treatment during the first 6 months. Recent evidence supports the replacement of IA with well-tolerated oral bedaquiline (BDQ) and a shortened 9–12 month regimen.

DESIGN: Using a Markov model, we analyzed the 5- year budgetary impact and cost per successful treatment outcome of four regimens: 1) IA long-course, 2) oral long-course, 3) IA short-course, and 4) oral short-course. We used the South African MDR/RR-TB case register (2013–2015) to assess treatment outcomes for the thenstandard IA long-course. Data on the improvement in
outcomes for BDQ-based regimens were based on the literature. Costs were estimated from the provider perspective using costs incurred to provide decentralized treatment for MDR-TB at a Johannesburg hospital.

RESULT S : Based on our analysis, by 2023, the cost/successful outcome for the four regimens was respectively 1) US$7374, 2) US$7860, 3) US$5149, and 4)US$4922. The annual total cost of each regimen was US$37 million, US$43 million, US$26 million, and US$28 million.

CONCLUS ION: Despite the high cost of BDQ, a BDQbased shortened regimen for the treatment of MDR/RRTB will result in improved treatment outcomes and cost
savings for South Africa.KEY WORDS : MDR-TB; bedaquiline; cost; cost-effectiveness;

Publication details

International Union Against Tuberculosis and Lung Disease