Abstract
Objective: To evaluate the cost-effectiveness of applying delamanid (Deltyba™) as an enhancement to a background regimen (BR) for treating MDR-TB in Germany.
Methods: A Markov model was established to compare the incremental cost-effectiveness of treating MDR-TB patients with delamanid plus BR versus a five drug- BR regimen alone, covering a period of 10 years. Cost per QALY and DALY were determined from a societal perspective. Recently published Germany-based MDR-TB cost data were applied to the 24-month outcome results of the phase II Otsuka´s Trial 204. Costs and effectiveness were discounted at a rate of 3% and a Monte Carlo simulation was used for probabilistic sensitivity analysis.
Results: Using current market prices, we determined the total discounted cost per patient on BR plus delamanid to be €142,731 versus €150,909 for BR alone. Appropriately discounted QALYs per patient were 8.47 for delamanid compared to 6.13 for BR alone. As such, BR-plus delamanid strategy dominated the BR-only strategy, with simultaneous savings of €8,177 and a gain of 2.34 QALYs. Delamanid was cost saving in 73% cases under probabilistic sensitivity analyses compared to BR alone and 100% cost effective at a willingness-to-pay threshold of €10,000.
Conclusions: Under German conditions, delamanid added to a five drug BR regimen is likely to be cost-saving compared to BR alone. Adding delamanid remained cost-effective when costs due to loss of productivity were excluded as the QALYs gained by lower lethality and a higher proportion of successfully treated patients outweighed the delamanid drug costs. These results strongly support the use of delamanid (Deltyba™) in the treatment MDR-TB patients.
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