PT - JOURNAL ARTICLE AU - Daniel Wirth AU - Ramesh Dass AU - Robert Hettle TI - Cost-effectiveness of adding novel or group 5 interventions to a background regimen for the treatment of multidrug-resistant tuberculosis in Germany AID - 10.1183/13993003.congress-2016.PA2681 DP - 2016 Sep 01 TA - European Respiratory Journal PG - PA2681 VI - 48 IP - suppl 60 4099 - http://erj.ersjournals.com/content/48/suppl_60/PA2681.short 4100 - http://erj.ersjournals.com/content/48/suppl_60/PA2681.full SO - Eur Respir J2016 Sep 01; 48 AB - Objectives: To evaluate the long-term costs and effectiveness of adding the novel/group 5 drugs bedaquiline and linezolid to a background regimen (BR) of drugs for treating multidrug-resistant tuberculosis (MDR-TB), from a German healthcare payer perspective.Methods: A cohort-based Markov model was developed to simulate the incremental cost-effectiveness ratio (ICER) of bedaquiline + BR or linezolid + BR versus BR alone in the treatment of MDR-TB, over a 10-year time horizon. Efficacy was evaluated in quality-adjusted life-years (QALYs) and life-years (LY), using inputs from the C208 clinical trial for bedaquiline and from a German observational study for linezolid. Cost data were obtained from German Drug Directory costs (€/2015), published literature, and expert opinion. A 3% yearly discount rate was applied. Sensitivity analyses were conducted.Results: The total discounted costs and QALYs per patient were €85,575 and 5.95 for bedaquiline + BR and €80,460 and 3.91 for linezolid + BR, compared with €60,962 and 3.68 for BR alone. Both bedaquiline and linezolid were therefore associated with higher QALYs and higher costs than BR alone, with ICERs of €22,238 for bedaquiline and €87,484 for linezolid, versus BR. In a fully incremental analysis, bedaquiline + BR was the most cost-effective option at thresholds >€22,000/QALY gained.Conclusions: In Germany, the addition of bedaquiline or linezolid to BR would result in QALY gains over BR alone. Based on this analysis, bedaquiline is likely to be the most cost-effective drug for the treatment of MDR-TB when added to BR, at thresholds >€22,000/QALY.