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 QALYs and LYG, 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.