OBJECTIVES To evaluate the cost-effectiveness of adding bedaquiline to the intensive phase of background regimens (BR) of drugs for multidrug-resistant tuberculosis (MDR-TB) in the United Kingdom (UK). METHODS A cohort-based Markov model was developed to estimate the incremental cost-effectiveness ratio of bedaquiline plus BR (B+BR) versus BR alone (BR) in the treatment of MDR-TB in the UK, over a 10-year horizon. A National Health Service (NHS) and personal social services perspective was considered. The effectiveness of treatment was evaluated in terms of Quality Adjusted Life Years (QALYs) and Disability Adjusted Life Years (DALYs). Data were sourced from a phase II, placebo controlled trial of bedaquiline, NHS reference costs, and the literature. Costs and effectiveness were discounted at a rate of 3.5% per annum. Probabilistic and deterministic sensitivity analysis was conducted.  RESULTS The total discounted cost per patient on B+BR was £107,123, compared with £116,616 for BR. The total discounted QALYs per patient were 4.85 for B+BR and 3.81 for BR. The addition of bedaquiline to BR resulted in cost-savings of £9,493 and an additional 1.04 QALYs pp over a 10-year period, and is therefore considered to be the dominant (less costly and more effective) strategy over BR. B+BR remained dominant versus BR in the majority of sensitivity analyses, with a 74% probability of being dominant versus BR in the probabilistic analysis.  CONCLUSIONS In the UK, bedaquiline is likely to be cost-effective and cost-saving, compared to the current standard of care for MDR-TB under a range of scenarios. Cost-savings over a 10 year period were realized from reductions in lengths of hospital stay, which offset  bedaquiline drug costs. Bedaquiline remained cost-saving in several sensitivity analyses,  highlighting the certainty surrounding the results of the model. These results also indicate that the B+BR regimen can provide significant social economic benefits versus the BR only regimen.