OBJECTIVES

To study the impact on the economic burden of drug-resistant tuberculosis (DR-TB) of the use of bedaquiline-containing regimens in Indonesia.

METHODS

A state transition model that captures the dynamics of drug-sensitive (DS) and DR-TB disease, including both latent and active states, was developed and calibrated to published data. Diagnostic and treatment-related infrastructure changes expected to take place were built in. The economic impact was aggregated across drug, hospitalization, diagnostics-related and patient out-of-pocket costs, and was measured in terms of national level DR-TB healthcare costs, cost per treated patient and cost per successfully treated patient. Catastrophic costs were considered to have been incurred by a household if out-of-pocket direct and indirect costs exceeded 20% of their annual income. Household income was simulated to factor in the variance in earnings and the treatment setting - private vs. public medical care. Three scenarios were evaluated – 1) without bedaquiline, 2) with bedaquiline, treatment success rate of 61% (Pym 2016), and 3) with bedaquiline, treatment success rate of 80% (Guglielmetti 2017).

RESULTS

During 2026-2030, direct DR-TB healthcare costs to the system were estimated in the three scenarios to be $650M, $424M (-35%) and $390M (-40%) respectively; costs per treated patient to be $11.1k, $7.5k (-33%) and $7.1k (-36%); costs per successfully-treated patient to be $27.1k, $13.7 k (-49%) and $10.1k (-63%); and catastrophically-affected households with DR-TB in the year 2030 to be 6.2k, 5.4k (-13%) and 5.1k (-17%).

CONCLUSIONS

Results of this analysis show that the economic burden of DR-TB in Indonesia will ease considerably with increased use of bedaquiline, both at the societal level, and for individual patients and their families, by decreasing overall healthcare cost, the cost per successfully treated patient, and the catastrophic costs borne by affected patients/families.