Cost-effectiveness evaluation of bedaquiline- and delamanid-containing regimens for multidrug-/rifampicin-resistant tuberculosis in China: a retrospective study based on three nationwide, real-world multicenter cohorts

Background: Bedaquiline and delamanid are novel anti-tuberculosis drugs approved in China and recommended by the World Health Organization, with demonstrated good efficacy and safety profile in clinical trials. However, health economic evaluations of these new drugs using modeling approaches are limited in China. This study aims to evaluate the cost-effectiveness of two novel drug containing regimens compared to traditional regimen in Chinese adult population. Methods: We performed a cost-effectiveness analysis from the perspective of the patient. Clinical treatment information and outcomes were retrospectively collected from the respective Electronic Data Collection systems. Patient costs were obtained via hospital records. A decision tree-Markov model was constructed, employing a 1-month cycle length, to simulate a 10-year life course of patients receiving different treatment regimens at the age of 39. Transition probabilities were informed by outcome data supplemented with literature sources. Outcomes included average costs, quality-adjusted life years (QALYs) and a cost-effectiveness comparison between novel drug containing regimens and traditional regimens. Results: The average diagnosis and treatment cost per case for regimens containing new drugs were higher than that for the traditional long-course regimen (traditional regimen: 95,142.74 CNY; bedaquiline-containing regimen: 149,837.33 CNY; delamanid-containing regimen: 140,351.38 CNY). However, the new drug containing regimens yielded more QALYs compared to traditional regimen (traditional regimen: 6.24 QALYs; bedaquiline-containing regimen: 6.81 QALYs; delamanid-containing regimen: 6.72 QALYs). Incremental cost, Incremental effectiveness and incremental cost-effectiveness ratio were 54,698.29 CNY, 0.59 QALYs, 100,029.40 CNY/QALY for cohort B and 45,212.35 CNY, 0.50 QALYs, 90,711.44 CNY/QALY for cohort C. Sensitivity analysis indicated a willingness-to-pay threshold of 105,323.9 CNY/QALY as the point with which the bedaquiline-containing regimen became the dominant cost-effective option. Conclusions: Both new drug-containing regimens demonstrated health economic value and can be recommended as novel treatment options for multidrug-resistant/rifampicin-resistant tuberculosis. However, further price reduction for these new drugs remains necessary to enhance affordability and accessibility.