{
  "abstract": "Introduction Prior to 2020, treatment options for multidrug-resistant tuberculosis (MDR-TB) were limited and typically involved long treatment durations and high financial burdens. In the eastern European and central Asian (EECA) region, traditional inpatient tuberculosis (TB) care models, alongside high MDR-TB rates, escalate nosocomial transmission risks and treatment costs. Modified, fully oral, shorter treatment regimens (mSTR) implemented in the WHO European Region under operational research conditions offered a potential reduction in the burden of MDR-TB treatment for both patients and health systems.Methods We conducted the first regional evaluation of the cost-effectiveness of the novel mSTR treatment regimen compared with the standard of care (SOC) in Belarus, Georgia, Kazakhstan and Republic of Moldova. We used cohort data on mSTR efficacy and WHO data on SOC in patients with MDR-TB. We used a Markov model, with treatment costs calculated from the provider perspective. Outcomes were measured in quality-adjusted life years (QALYs), with incremental cost-effectiveness ratios (ICER) calculated per QALY gained in each country. An annual 3% discount rate was used for both costs and outcomes. We performed univariate and probabilistic sensitivity analysis (PSA) to assess the robustness of our cost-effectiveness calculations under varying assumptions. Finally, we estimated potential cost savings if mSTR was implemented nationally and we evaluated the incremental net monetary benefit (iNMB) and willingness-to-pay (WTP) thresholds based on Wood et al’s country-level cost-effectiveness thresholds. All costs were reported in 2022 USD.Results We estimated that mSTR can reduce TB treatment costs by between 23% and 47% and drug costs by 39% to 74%, compared with SOC in the countries studied. mSTR resulted in cost savings of between $3596 and $8174 per patient and offered additional health gains of between 0.56 to 2.69 QALYs per patient. mSTR remained cost-effective (iNMB>0) compared with SOC in 78%, 85%, 91% and 92% of PSA simulations in Belarus, Georgia, Kazakhstan and Republic of Moldova, respectively, when compared with their country-level WTP threshold. Implementing mSTR in up to 80% of MDR/rifampicin-resistant TB patients may result in cost savings of $20.5, 2.5, 0.7 and 0.2 million in Kazakhstan, Belarus, Republic of Moldova and Georgia; equivalent to 17%, 3%, 4% and 1% of their national TB budgets, respectively.Conclusions Compared with SOC, mSTR is a more cost-effective treatment option for MDR/RR-TB, which should be considered by policymakers in the EECA region. Using insights from current implementations to scale up, plan operational changes and reallocate savings from mSTR could greatly enhance TB services and patient care.",
  "authors": [
    {
      "affiliations": [
        "Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK",
        "Institute for Global Health, University College London, London, UK"
      ],
      "name": "Kasim Allel"
    },
    {
      "affiliations": [
        "Institute for Global Health, University College London, London, UK"
      ],
      "name": "Tom Palmer"
    },
    {
      "affiliations": [
        "Institute for Global Health, University College London, London, UK"
      ],
      "name": "Gerard Joseph Abou Jaoude"
    },
    {
      "affiliations": [
        "World Health Organization Regional Office for Europe, Copenhagen, Denmark"
      ],
      "name": "Oleksandr Korotych"
    },
    {
      "affiliations": [
        "World Health Organization Regional Office for Europe, Copenhagen, Denmark"
      ],
      "name": "Askar Yedilbayev"
    },
    {
      "affiliations": [
        "Institute of Phthisiopneumology, Chisinau, Moldova (the Republic of)"
      ],
      "name": "Valentina Vilc"
    },
    {
      "affiliations": [
        "Institute of Phthisiopneumology, Chisinau, Moldova (the Republic of)"
      ],
      "name": "Andrei Corloteanu"
    },
    {
      "affiliations": [
        "Institute of Phthisiopneumology, Chisinau, Moldova (the Republic of)"
      ],
      "name": "Mariana Macari"
    },
    {
      "affiliations": [
        "Institute of Phthisiopneumology, Chisinau, Moldova (the Republic of)"
      ],
      "name": "Cula Evghenia"
    },
    {
      "affiliations": [
        "The Global Fund to Fight AIDS Tuberculosis and Malaria, Grand-Saconnex, Genève, Switzerland"
      ],
      "name": "Dumitru Laticevschi"
    },
    {
      "affiliations": [
        "National Scientific Center of Phthisiopulmonology of the Republic of Kazakhstan, Almaty, Kazakhstan"
      ],
      "name": "Ismailov Shakhimurat-Shaimovich"
    },
    {
      "affiliations": [
        "National Scientific Center of Phthisiopulmonology of the Republic of Kazakhstan, Almaty, Kazakhstan"
      ],
      "name": "Rakisheva Anar-Saduakasovna"
    },
    {
      "affiliations": [
        "National Scientific Center of Phthisiopulmonology of the Republic of Kazakhstan, Almaty, Kazakhstan"
      ],
      "name": "Tulepova Gulzhan-Elbrusovna"
    },
    {
      "affiliations": [
        "National Scientific Center of Phthisiopulmonology of the Republic of Kazakhstan, Almaty, Kazakhstan"
      ],
      "name": "Daria Anatolievna-Ryazanet"
    },
    {
      "affiliations": [
        "National Scientific Center of Phthisiopulmonology of the Republic of Kazakhstan, Almaty, Kazakhstan"
      ],
      "name": "Aimbekova Shahrizada-Yergalymovna"
    },
    {
      "affiliations": [
        "Republican Scientific and Practical Center for Pulmonology and Tuberculosis, Minsk, Belarus"
      ],
      "name": "Natalia Yatskevich"
    },
    {
      "affiliations": [
        "Republican Scientific and Practical Center for Pulmonology and Tuberculosis, Minsk, Belarus"
      ],
      "name": "Alena Skrahina"
    },
    {
      "affiliations": [
        "Republican Scientific and Practical Center for Pulmonology and Tuberculosis, Minsk, Belarus"
      ],
      "name": "Dmitry Zhurkin"
    },
    {
      "affiliations": [
        "National Center for Tuberculosis and Lung, Tbilisi, Georgia"
      ],
      "name": "Zaza Avaliani"
    },
    {
      "affiliations": [
        "National Center for Tuberculosis and Lung, Tbilisi, Georgia"
      ],
      "name": "Nana Kiria"
    },
    {
      "affiliations": [
        "National Center for Tuberculosis and Lung, Tbilisi, Georgia"
      ],
      "name": "Nino Lomtadze"
    },
    {
      "affiliations": [
        "National Center for Tuberculosis and Lung, Tbilisi, Georgia"
      ],
      "name": "Nino Kiria"
    },
    {
      "affiliations": [
        "National Center for Tuberculosis and Lung, Tbilisi, Georgia"
      ],
      "name": "Teona Avaliani"
    },
    {
      "affiliations": [
        "National Center for Disease Control and Public Health, Tbilisi, Georgia"
      ],
      "name": "Irma Khonelidze"
    },
    {
      "affiliations": [
        "National Center for Disease Control and Public Health, Tbilisi, Georgia"
      ],
      "name": "Maka Danelia"
    },
    {
      "affiliations": [
        "The Global Fund to Fight AIDS Tuberculosis and Malaria, Grand-Saconnex, Genève, Switzerland"
      ],
      "name": "Corina Maxim"
    },
    {
      "affiliations": [
        "Institute for Global Health, University College London, London, UK"
      ],
      "name": "Hassan Haghparast-Bidgoli"
    },
    {
      "affiliations": [
        "Institute for Global Health, University College London, London, UK"
      ],
      "name": "Jolene Skordis"
    }
  ],
  "title": "Cost-effectiveness of modified fully oral 9-month treatment regimens for rifampicin-resistant tuberculosis in Belarus, Georgia, Kazakhstan and the Republic of Moldova",
  "uid": "ad0070da-b9f4-5474-9358-6cc7df8b50ce"
}