<![CDATA[This conceptual review examines whether published cost-effectiveness models of bedaquiline and delamanid account for diagnostic and pretreatment delays in multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB). Evidence was retrieved through targeted searches of an AI-assisted medical evidence platform indexing Springer Nature, Wiley, NEJM Group, and JAMA Network. Searches covered five domains: diagnostic delays in Bandung’s MDR/RR-TB care cascade; clinical and epidemiological consequences; the structure of six bedaquiline/delamanid cost-effectiveness models; evidence for diagnostic and informatics interventions; and precedents for incorporating delays into economic models. Thirty-two unique studies were included. A four-year Bandung cascade analysis found that fewer than one in ten estimated MDR/RR-TB cases were diagnosed; this finding is specific to that study and is not a national estimate. Evidence from comparable high-burden settings links delays to greater disease severity, poorer treatment outcomes, and prolonged infectiousness. None of the six identified drug cost-effectiveness models formally parameterized diagnostic delay or diagnostic informatics performance. Their simulated horizons began at treatment initiation, while sensitivity analyses emphasized drug prices, outcome probabilities, and adverse-event costs. However, discrete-event simulation and related approaches have incorporated treatment waiting times into economic models in oncology and bloodstream infections. This review does not develop or validate a new economic model. It proposes a conceptual framework positioning diagnostic informatics as a determinant of therapeutic value in MDR/RR-TB. The framework aims to guide empirical research incorporating locally observed delay distributions into cost-effectiveness models for Indonesia and other high-burden settings.]]>
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