Cost-Effectiveness Analysis of Rifampicin and Bedaquiline Use for Tuberculosis Treatment: A Systematic Review

wawang anwarudin

doi:10.30595/jhepr.v4i1.442

Authors

wawang anwarudin Faculty of Pharmacy, Health and Science, Universitas Muhammadiyah Kuningan, Kuningan, West Java, Indonesia.

DOI:

https://doi.org/10.30595/jhepr.v4i1.442

Keywords:

Bedaquiline, Cost-Effectiveness, ICER, MDR-TB, Rifampicin

Abstract

Introduction: Multidrug-resistant tuberculosis (MDR-TB), particularly rifampicin-resistant tuberculosis (RR-TB), remains a major challenge to global tuberculosis control and imposes substantial economic burdens on healthcare systems. Since 2020, the World Health Organization (WHO) has recommended the use of bedaquiline, a novel oral anti-tuberculosis drug, as part of an all-oral shorter regimen for the treatment of MDR-TB. This recommendation aims to improve treatment outcomes while reducing treatment duration and toxicity associated with conventional regimens.

Materials and Methods: This study employed a systematic review approach of peer-reviewed articles published between 2020 and 2026. A total of 14 studies were included in the analysis. The selected studies evaluated cost-effectiveness outcomes such as direct medical costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Various pharmacoeconomic modeling methods were applied in the included studies, including Markov models, decision tree analyses, and randomized controlled trials.

Result: Most of the reviewed studies reported that bedaquiline-based regimens are more cost-effective compared with conventional rifampicin-based therapy. The ICER values were generally below the national willingness to pay thresholds, indicating favorable economic value. In several studies, bedaquiline-based regimens even demonstrated cost-saving potential. In particular, the BPaL regimen (bedaquiline, pretomanid, and linezolid) showed shorter treatment duration, improved clinical outcomes, and lower relapse and resistance rates.

Conclusion: Bedaquiline represents a clinically effective and economically efficient treatment option for MDR-TB. Its implementation should be prioritized in national tuberculosis control programs, especially in low and middle income countries with a high TB burden. Further real-world implementation studies are necessary to support broader integration into healthcare systems.

Keywords: Bedaquiline, cost-effectiveness, MDR-TB, rifampicin, ICER

References

World Health Organization. Global Tuberculosis Report 2023. Geneva: World Health Organization; 2023.

Laurence YV, Griffiths UK, Vassall A. Costs to health services and the patient of treating tuberculosis: a systematic literature review. Pharmacoeconomics. 2015;33(9):939–955.

van den Hof S, Collins D, Hafidz F, et al. The socioeconomic impact of multidrug-resistant tuberculosis on patients: results from Ethiopia, Indonesia and Kazakhstan. BMC Infect Dis. 2016;16:470.

Weerasuriya CK, Clark TG, White RG, et al. The global burden of multidrug-resistant tuberculosis: epidemiology and transmission dynamics. Lancet Infect Dis. 2022;22(9):e232–e241.

Gu S, Liu Y, Zhang Y, et al. Cost and treatment outcomes of WHO-recommended regimens for rifampicin-resistant tuberculosis: a cohort analysis in China. Int J Infect Dis. 2024;134:45–52.

Conradie F, Diacon AH, Ngubane N, et al. Treatment of highly drug-resistant pulmonary tuberculosis with bedaquiline, pretomanid, and linezolid (BPaL regimen). N Engl J Med. 2022;382:893–902.

Nyang’wa BT, Berry C, Kazounis E, et al. A 24-week, all-oral regimen for rifampicin-resistant tuberculosis. N Engl J Med. 2022;387:2331–2343.

Gomez GB, Siapka M, Tacconelli E, et al. Cost-effectiveness of the BPaL regimen for the treatment of extensively drug-resistant tuberculosis. Lancet Glob Health. 2021;9(6):e748–e757.

Xu C, Pang Y, Li R, et al. Cost-effectiveness of bedaquiline-containing regimens for multidrug-resistant tuberculosis treatment in China. Infect Dis Poverty. 2023;12:89.

Houben RMGJ, Menzies NA, Sumner T, et al. Feasibility of achieving the WHO End TB targets by 2035: a modelling study. Lancet Glob Health. 2022;10(7):e1044–e1052.

Cox H, Hughes J, Daniels J, et al. Programmatic outcomes of bedaquiline-containing regimens for drug-resistant tuberculosis in high-burden countries. Clin Infect Dis. 2023;76(5):e1123–e1131.

Knight GM, McQuaid CF, Dodd PJ, et al. The impact and cost-effectiveness of new tuberculosis treatment regimens. Lancet Infect Dis. 2022;22(4):e101–e109.

Marx FM, Menzies NA, Salomon JA, et al. Cost-effectiveness of screening for latent tuberculosis infection among asylum seekers in Germany. Euro Surveill. 2021;26(14):2001349.

Yang C, Moyo S, Mwansa J, et al. Cost-effectiveness of community-based predictive screening for tuberculosis in Southern Africa. BMC Public Health. 2024;24:1123.

Ilaiwy A, Tupasi TE, Garcia M, et al. Cost-effectiveness of tuberculosis preventive therapy strategies for household contacts in the Philippines. PLOS Glob Public Health. 2025;5(2):e0002450.

Rosu S, Kendall EA, Fofana MO, et al. Economic evaluation of a shorter all-oral regimen for rifampicin-resistant tuberculosis. BMJ Glob Health. 2020;5:e002763.

Navarro S, Gomez LM, Rojas L, et al. Cost-effectiveness of QuantiFERON versus tuberculin skin test for latent tuberculosis diagnosis in immunosuppressed children. Pediatr Infect Dis J. 2025;44(3):215–221.

Amoako YA, Phillips RO, Asiedu K, et al. High-dose rifampicin versus standard dose in mycobacterial infection: clinical and economic outcomes from a randomized trial. Clin Infect Dis. 2022;75(8):1432–1440.

Nsengiyumva NP, Menzies NA, Oxlade O, et al. Targeted tuberculosis preventive therapy among people living with HIV and household contacts: a modelling analysis. Lancet Glob Health. 2022;10:e120–e129.

Evans D, Schnippel K, Rosen S, et al. Cost and cost-effectiveness of the BPaL regimen for drug-resistant tuberculosis treatment in South Africa. Int J Tuberc Lung Dis. 2024;28(2):120–128.

Dodd PJ, Sismanidis C, Seddon JA. Global burden and cost-effectiveness of household contact management for multidrug-resistant tuberculosis. Lancet Glob Health. 2022;10:e1200–e1209.

Afifah N, Setiawan D, Postma MJ. Cost-effectiveness of Bacillus Calmette–Guérin (BCG) vaccination in Indonesia: a modelling study. Vaccine. 2020;38(32):4985–4992.