An economic evaluation published in the Indian Journal of Medical Research has shown that shorter, six-month all-oral treatment regimens for multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) are cost-effective and deliver better health outcomes than the longer regimens currently used in India.
ICMR-NIRT Evaluates Bedaquiline-Based Regimens
Researchers from the ICMR–National Institute for Research in Tuberculosis (ICMR-NIRT) conducted the study. They evaluated the cost-effectiveness of two bedaquiline-based regimens—BPaL (bedaquiline, pretomanid, and linezolid) and BPaLM (which additionally includes moxifloxacin). The team compared these six-month regimens with the existing bedaquiline-containing shorter (9–11 months) and longer (18–20 months) regimens implemented under the National TB Elimination Programme (NTEP).
BPaL Demonstrates Cost Savings and Superior Outcomes
As reported by pib.gov.in, the analysis clearly demonstrated that the BPaL regimen is both more effective and cost-saving. Specifically, for every additional Quality Adjusted Life Year (QALY) gained, the health system spends INR 379 less per patient compared to the current standard regimen. Therefore, BPaL not only improves patient outcomes but also reduces overall healthcare expenditure.
BPaLM Also Highly Cost-Effective
Similarly, the BPaLM regimen proved to be highly cost-effective. For each additional QALY gained, the health system incurs an incremental cost of only INR 37 per patient compared to the standard regimen. Moreover, both BPaL and BPaLM regimens demonstrated lower or comparable overall healthcare costs, including expenses related to medicines, hospital visits, and follow-up care.
Addressing the Burden of Drug-Resistant TB
MDR/RR-TB presents significant clinical and economic challenges. Prolonged treatment duration, adverse drug effects, and higher costs often compromise patient adherence and outcomes. However, shorter all-oral regimens can improve compliance, reduce morbidity, and enable patients to resume normal life sooner. At the same time, these regimens reduce the financial and operational burden on the healthcare system.
Aligning with National TB Elimination Goals
Importantly, by reducing treatment duration from 9–18 months or longer to just six months, these regimens align with national priorities to optimise resource utilisation and accelerate progress towards TB elimination. Consequently, the findings provide strong economic evidence to support the broader adoption of shorter, all-oral regimens for MDR/RR-TB management in India.
Implications for Programmatic Adoption
The study concludes that BPaL-based regimens are likely to be cost-saving or highly cost-effective. Therefore, policymakers may consider incorporating these regimens into programmatic use under the NTEP to strengthen India’s response to drug-resistant TB and advance its elimination goals.