OBJECTIVES : To assess the impact of bedaquiline-containing regimens on healthcare costs and catastrophic costs to families of patients with drug-resistant tuberculosis (DR-TB) in India.

METHODS : A state transition model that allows flow and interaction between three TB states (susceptible, latent and active), and between drug-sensitive (DS) and DR-TB patients, was developed and calibrated to published metrics. Future expected infrastructural changes were built in to the model. Healthcare costs, both direct (including hospitalization, drug costs, adverse events) and indirect (productivity loss), were considered, separately in various treated and untreated stages. Economic impact was measured at societal level in terms of DR-TB healthcare costs to the system, and at an individual patient level in terms of cost per treated patient and cost per successfully treated patient. Cost for a family was taken to be catastrophic where out-of-pocket costs exceeded 20% of their income. The model was used to estimate costs in the baseline (without bedaquiline, scenario-1) and to assess the impact of bedaquiline-containing regimens (95% peak share) in two additional scenarios with regimen treatment success rate of 61% (Pym 2016) in scenario-2 and 80% (Guglielmetti 2017) in scenario-3.

RESULTS : In 2030, for scenarios 1, 2 and 3, DR-TB healthcare costs were $1.0B, $548M (-46%) and $420M (-58%) respectively; costs per treated patient were $12.2k, $7.9k (-36%) and $7.2k (-41%) respectively; costs per successfully-treated patient were $29.4k, $13.8k (-53%) and $9.4k (-68%) respectively; and families of DR-TB patients facing catastrophic costs were 38.4k, 31.8k (-17%) and 26.4k (-31%) respectively.

CONCLUSIONS : The adoption of bedaquiline-containing regimens significantly reduces the economic DR-TB burden in India at the societal and individual level, by reducing overall healthcare cost and the cost per successfully treated patient, and the catastrophic cost impact posed to affected families. These factors advocate the adoption of bedaquline as the backbone regimen for DR-TB treatment.