OBJECTIVES: The Brazilian Public Health System (Sistema Único de Saúde - SUS) aims to strongly reduce incidence and deaths related to tuberculosis until 2035. This study presents a cost-effectiveness analysis of shortening treatment for multidrug-resistant (MDR-TB), including also bedaquiline.

METHODS: A Markov model simulated natural disease progression and treatment intervention for adults with MDR-TB diagnosis, with characteristics drawn from Ministry of Health (MoH) and literature data. Costs and outcomes were compared for 3 strategies: (A) a short regimen with current drugs; (B) short regimen with only oral drugs and bedaquiline inclusion; (C) long regimen, as standard currently available. The two short regimens last 9 months and the long one, 18 months. Rates for background and tuberculosis-related mortality, disease progression, cure, health-related quality of life, disability coefficient were extracted from MoH and literature review. The direct costs, comprehending outpatient and inpatient fees, and the drug prices were estimated in the public payer perspective. Discount rate was 3% for costs and outcomes. Incremental cost-effectiveness ratios (ICERs) were analyzed according to GDP per capita (US$ 8,843), applying a conversion of 0.278 real per dollar. Deterministic and probabilistic sensitivity analysis were performed.

RESULTS: The regimen B has shown to be the best option, with a reduced cost associated to a greater benefit. This cost-saving strategy presented a cost of US$ 10,186, compared A and C, with US$ 10,503 and US$ 21,035, respectively. The sensitivity analyses allowed to confirm that even facing the uncertainties from the input parameters, no changing occurred with the direction of baseline results.

CONCLUSIONS: The shorter lasting strategies to treat MDR-TB seems to be cost-saving for the Brazilian context, with better benefit with bedaquiline use. These findings may take in account the susceptibility assays, lack of access for molecular diagnostic tests necessary for short regimens and the availability of drugs in the real practice.