Cost-effectiveness analysis of bedaquiline-containing regimens for the treatment of patients with multidrug/rifampicin-resistant pulmonary tuberculosis in Nanning: a retrospective cohort study

doi:10.19982/j.issn.1000-6621.20240553

Abstract

Abstract:

Objective: To evaluate the efficacy, safety, and cost-effectiveness of bedaquiline-containing regimens for the treatment of multidrug/rifampicin-resistant tuberculosis (TB) patients in Nanning, Guangxi Zhuang Autonomous Region. Methods: Adult multidrug/rifampicin-resistant TB patients admitted to the Fourth People’s Hospital of Nanning from January 2019 to January 2024 were included. Patients were divided into two groups based on their treatment regimens: the conventional long-course regimen group (conventional group) and the bedaquiline-containing regimen group (bedaquiline group). Data on patients’ demographic characteristics, treatment process, treatment outcomes, adverse reactions, and treatment costs were collected and analyzed statistically. Results: A total of 521 patients were included in the study, with 134 in the bedaquiline group and 387 in the conventional group. The proportion of patients with favorable treatment outcomes in the bedaquiline group was 82.1% (110/134), significantly higher than that in the conventional group (63.3%, 245/387), with a statistically significant difference (χ²=16.173, P=0.001). The incidence of adverse reactions in the bedaquiline group was 31.3% (42/134), which was not significantly different from that in the conventional group (35.4%, 137/387)(χ²=0.726, P=0.394). There were no deaths in the bedaquiline group, while 24 patients died in the conventional group. The loss-to-follow-up rate in the conventional group was 24.0% (93/387), significantly higher than that in the bedaquiline group (12.7%, 17/134), with a statistically significant difference (χ²=7.691, P=0.006). The median treatment cost in the bedaquiline group was 11.0 (10.2,11.8) ten thousand yuan, significantly higher than that in the conventional group 6.6 (6.1, 7.7) ten thousand yuan, with a statistically significant difference (Z=75078.000, P=0.001). Cost-effectiveness analysis showed that the medical cost per successfully treated patient was 106000 yuan in the conventional group and 134000 yuan in the bedaquiline group. Conclusion: Although the treatment cost of bedaquiline is relatively high, its success rate is also relatively high, and its safety is good. It can provide more treatment options for rifampicin-resistant TB patients.

Key words: Tuberculosis, multidrug-resistant, Bedaquiline, Cost-benefit analysis, Therapeutics, Retrospective studies

CLC Number:

R521

Wei Liuying, Jing Wei, Liu Zhifeng, Nie Wenjuan, Huang Xianzhen, Huang Lianpiao, Ban Fengting, Lin Yanrong, Yang Shixiong, Zhu Qingdong. Cost-effectiveness analysis of bedaquiline-containing regimens for the treatment of patients with multidrug/rifampicin-resistant pulmonary tuberculosis in Nanning: a retrospective cohort study[J]. Chinese Journal of Antituberculosis, 2025, 47(7): 914-920. doi: 10.19982/j.issn.1000-6621.20240553

Figures/Tables 5

References 24

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特征	传统组(387例)	贝达喹啉组(134例)	统计检验值	P值
性别[例(构成比,%)]			χ²=0.463	0.496
男性	292(75.5)	105(78.4)
女性	95(24.5)	29(21.6)
年龄范围(岁)	14~82	15~72
平均年龄(岁,$\bar{x}±s$)	43.8±15.6	42.4±13.1	t=0.945	0.173
体质量指数范围	12.0~33.0	12.6~27.1
平均体质量指数($\bar{x}±s$)	19.2±4.0	20.6±3.4	t=1.258	0.335
吸烟史[例(发生率,%)]	180(46.5)	58(43.3)	χ²=3.206	0.073
饮酒史[例(发生率,%)]	157(40.6)	49(36.6)	χ²=2.636	0.268
白蛋白范围(g/L)	19.8~51.8	20.2~49.4
平均白蛋白水平(g/L,$\bar{x}±s$)	37.5±4.7	38.4±5.6	t=―1.936	0.053
耐药种类[例(构成比,%)]			χ²=0.722	0.697
利福平耐药	17(4.4)	7(5.2)
耐多药	270(69.8)	97(72.4)
广泛耐药	100(25.8)	30(22.4)
既往治疗史[例(发生率,%)]	309(79.8)	104(77.6)	χ²=0.302	0.583
合并症[例(发生率,%)]
糖尿病	63(16.3)	23(17.2)	χ²=0.190	0.663
乙型肝炎	27(7.0)	9(6.7)	χ²=0.010	0.918
肺部空洞[例(发生率,%)]	279(72.1)	106(79.1)	χ²=2.537	0.111

治疗结局	传统组			贝达喹啉组			χ²值^a	P值^a
治疗结局	小计 (387例)	A组 (217例)	B组 (170例)	小计 (134例)	C组 (75例)	D组 (59例)	χ²值^a	P值^a
良好结局	245(63.3)	129(59.4)	114(67.1)	110(82.1)	61(81.3)	49(83.1)	16.173	0.001
治愈	152(39.3)	79(36.4)	72(42.4)	65(48.5)	36(48.0)	29(49.2)	3.490	0.062
完成治疗	93(24.0)	50(23.0)	42(24.7)	45(33.6)	25(33.3)	20(33.9)	4.663	0.031
不良结局	142(36.7)	88(40.6)	56(32.9)	24(17.9)	14(18.7)	10(16.9)	16.173	0.001
治疗失败	25(6.5)	15(6.9)	12(7.1)	7(5.2)	4(5.3)	3(5.1)	0.264	0.608
死亡	24(6.2)	15(6.9)	9(5.3)	0(0.0)	0(0.0)	0(0.0)	8.711	0.003
失访	93(24.0)	58(26.7)	35(20.6)	17(12.7)	10(13.3)	7(11.9)	7.691	0.006

不良反应	传统组(387例)			贝达喹啉组(134例)			χ²值^a	P值^a
不良反应	例数	发生率(%)	起数	例数	发生率(%)	起数	χ²值^a	P值^a
皮肤变色	57	14.7	57	17	12.7	17	0.341	0.559
肝损伤	36	9.3	57	10	7.5	19	0.418	0.518
高尿酸血症	18	4.7	26	5	3.7	10	0.200	0.655
白细胞减少	10	2.6	20	3	2.2	7	0.049	0.825
胃肠道反应	4	1.0	15	2	1.5	7	0.184	0.668
QT间期延长	5	1.3	16	1	0.7	4	0.260	0.610
精神症状	2	0.5	7	1	0.7	3	0.092	0.762
其他^b	5	1.3	20	3	2.2	9	0.590	0.442
合计	137	35.4	218	42	31.3	76	0.726	0.394

分组	费用合计 [万元, M(Q₁,Q₃)]	药品费用 [万元, M(Q₁,Q₃)]	检验检查费用 [万元, M(Q₁,Q₃)]	不良反应治疗费用[万元, M(Q₁,Q₃)]	良好结局率 (%)	成本/效果 (万元/例)
传统组	6.6(6.1,7.7)	5.2(4.7,5.9)	0.5(0.4,0.6)	0.9(0.8,1.0)	63.3	10.6
A组	6.0(5.9,6.8)	4.6(4.3,5.6)	0.4(0.3,0.5)	0.9(0.7,1.1)	59.3	10.3
B组	7.9(6.2,8.2)	6.5(5.9,6.8)	0.4(0.3,0.5)	0.8(0.6,1.0)	67.3	11.9
贝达喹啉组	11.0(10.2,11.8)	10.3(9.5,11.1)	0.4(0.3,0.4)	0.4(0.3,0.4)	82.1	13.4
C组	10.6(9.8,11.6)	9.9(9.6,11.2)	0.3(0.3,0.5)	0.3(0.2,0.4)	80.3	13.3
D组	11.6(9.9,12.1)	11.1(9.7,11.6)	0.3(0.3,0.4)	0.2(0.2,0.3)	83.9	13.9