Evidence map›Paper›PMID 34862287›Full record

ArticleBMJ open2021

Cost-effectiveness of bedaquiline, pretomanid and linezolid for treatment of extensively drug-resistant tuberculosis in South Africa, Georgia and the Philippines.

Gabriela Beatriz Gomez, Mariana Siapka, Francesca Conradie, Norbert Ndjeka, Anna Marie Celina Garfin, Nino Lomtadze, Zaza Avaliani, Nana Kiria, Shelly Malhotra, Sarah Cook-Scalise and 4 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
27citing papers in PubMed, 2 pooled it
1.4field-weighted citation impact, top 15% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

27 citing papers in PubMed, 2 syntheses or guidelines pooled it, 29 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 9 institutions in 6 countries.

Gabriela Beatriz GomezDepartment of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK gabriela.gomez@lshtm.ac.uk.ORCID 0000-0002-7409-798X
Mariana SiapkaDepartment of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Francesca ConradieClinical HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
Norbert NdjekaNational TB Programme, South Africa Department of Health, Pretoria, Gauteng, South Africa.ORCID 0000-0001-6200-1592
Anna Marie Celina GarfinNational Tuberculosis Control Program, Bureau of Disease Prevention and Control, Department of Health, Manila, The Philippines.
Nino LomtadzeDepartment of TB Surveillance and Strategic Planning, National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia.
Zaza AvalianiDepartment of TB Surveillance and Strategic Planning, National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia.
Nana KiriaDepartment of TB Surveillance and Strategic Planning, National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia.
Shelly MalhotraTB Alliance, New York, New York, USA.
Sarah Cook-ScaliseTB Alliance, New York, New York, USA.
Sandeep JunejaTB Alliance, New York, New York, USA.
Daniel EverittTB Alliance, New York, New York, USA.
Melvin SpigelmanTB Alliance, New York, New York, USA.
Anna VassallDepartment of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
National Center for Tuberculosis and Lung Disease · GETB Alliance · USLondon School of Hygiene & Tropical Medicine · GBDepartment of Health · ZADepartment of Health · PHInternational AIDS Vaccine Initiative · USSanofi (France) · FRUnited States Agency for International Development · USUniversity of the Witwatersrand · ZA

Funding

Emory-Georgia TB Research Training ProgramD43TW007124 · FIC · EMORY UNIVERSITY · PI HENRY M BLUMBERG, Nestani Tukvadze · 2004 to 2026
$4.6M
FIC NIH HHS D43 TW007124
6 · The paper itself

Abstract

objectivesPatients with highly resistant tuberculosis have few treatment options. Bedaquiline, pretomanid and linezolid regimen (BPaL) is a new regimen shown to have favourable outcomes after six months. We present an economic evaluation of introducing BPaL against the extensively drug-resistant tuberculosis (XDR-TB) standard of care in three epidemiological settings.

designCost-effectiveness analysis using Markov cohort model.

settingSouth Africa, Georgia and the Philippines.

participantsXDR-TB and multidrug-resistant tuberculosis (MDR-TB) failure and treatment intolerant patients.

interventionsBPaL regimen. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Incremental cost per disability-adjusted life years averted by using BPaL against standard of care at the Global Drug Facility list price. (2) The potential maximum price at which the BPaL regimen could become cost neutral.

resultsBPaL for XDR-TB is likely to be cost saving in all study settings when pretomanid is priced at the Global Drug Facility list price. The magnitude of these savings depends on the prevalence of XDR-TB in the country and can amount, over 5 years, to approximately US$ 3 million in South Africa, US$ 200 000 and US$ 60 000 in Georgia and the Philippines, respectively. In South Africa, related future costs of antiretroviral treatment (ART) due to survival of more patients following treatment with BPaL reduced the magnitude of expected savings to approximately US$ 1 million. Overall, when BPaL is introduced to a wider population, including MDR-TB treatment failure and treatment intolerant, we observe increased savings and clinical benefits. The potential threshold price at which the probability of the introduction of BPaL becoming cost neutral begins to increase is higher in Georgia and the Philippines (US$ 3650 and US$ 3800, respectively) compared with South Africa (US$ 500) including ART costs.

conclusionsOur results estimate that BPaL can be a cost-saving addition to the local TB programmes in varied programmatic settings.

Indexed as

Extensively Drug-Resistant TuberculosisTuberculosis, Multidrug-ResistantAntitubercular AgentsCost-Benefit AnalysisDiarylquinolinesGeorgiaHumansLinezolidNitroimidazolesPhilippinesSouth AfricaAntitubercular AgentsbedaquilineDiarylquinolinesLinezolidNitroimidazolespretomanideconomicspublic healthtuberculosis

Identifiers

PMID34862287
PMCPMC8647530
OpenAlexW3216121518

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.