Abstract

Objective: To carry out a cost-minimization and budgetary impact assessment for the incorporation of cycloserine as a second-line drug in the treatment scheme for multidrug-resistant tuberculosis in the Brazilian Unified Health System (SUS).

Methods: The analysis of cost-minimization and budgetary impact followed the recommendations of the Methodological Guideline for Economic Evaluation and the Methodological Guideline for the Assessment of Budgetary Impact. A model was proposed using a simple decision tree with a base case composed of two scenarios: the reference one, using terizidone as a second-line medication standardized by the Ministry of Health in the therapeutic regimen of patients with MDR-TB, and the alternative scenario, using cycloserine.

Results: The safety outcomes were not considered to be adverse effects. No studies were found that assessed the cure rate outcome. A single study estimated the relative risk (RR) for treatment failure or relapse outcome for longer MDR-TB regimens, suggesting that cycloserine and terizidone have the same efficacy, considering the analyzed outcomes.

Conclusion: Cycloserine can be cost-effective. It must be considered that the incremental cost of incorporating cycloserine can be R$ 2,829,825.60, with a budgetary impact that can reach more than R$ 12 million, resulting in an increase of 26% to 29% in public spending in 5 years. These resources could be applied to other measures that may represent greater benefits for these patients.

Keywords: Cycloserine; Terizidone; Tuberculosis; Cost-Benefit Analysis; Budgetary Impact Analysis

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