- A six-month all-oral regimen for MDR/RR-TB is more effective and cost-saving in India
- The BPaL regimen costs INR 379 less per patient per additional QALY gained than standard care
- Shorter six-month treatment may improve adherence and reduce healthcare costs and patient morbidity
A six-month, all-oral treatment regimen for multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) is not only more effective but also cost-saving compared to the longer therapies currently used in India, according to a study published in the Indian Journal of Medical Research (IJMR).
The economic evaluation, conducted by the ICMR-National Institute for Research in Tuberculosis (ICMR-NIRT), assessed the cost-effectiveness of two newer regimens-BPaL (bedaquiline, pretomanid and linezolid) and BPaLM (with moxifloxacin)-against the existing bedaquiline-containing shorter (9-11 months) and longer (18-20 months) regimens used under the National TB Elimination Programme (NTEP).
The study concluded that "BPaL-based regimens are likely to be cost-saving or highly cost-effective and may be considered for programmatic adoption under the NTEP."
Better Outcomes At Lower Cost
The analysis found that the BPaL regimen is "both more effective and cost-saving" compared to the current standard of care.
"For each additional Quality Adjusted Life Year (QALY) gained, the health system spends INR 379 less per patient compared to the standard regimen," the study noted. This means patients gain better health outcomes while the public health system spends less.
The BPaLM regimen was also found to be "highly cost-effective," with an additional expenditure of just INR 37 per patient per additional QALY gained compared to the standard regimen.
Importantly, the researchers observed that both six-month regimens were associated with "lower or comparable overall healthcare costs, including medicines, hospital visits, and follow-up care."
Shorter Treatment, Fewer Challenges
MDR/RR-TB treatment in India currently lasts anywhere between 9 and 20 months, depending on the regimen. Such prolonged treatment is often associated with adverse effects, high costs and poor adherence.
"MDR/RR-TB poses significant treatment challenges due to prolonged treatment duration, adverse effects, and higher costs," the study said.
By reducing the treatment duration to six months, the all-oral regimens could improve adherence, reduce patient morbidity and enable faster return to normal life, while also lowering the burden on the health system.
Boost To India's TB Elimination Goals
India carries one of the highest burdens of drug-resistant TB globally. The findings offer critical economic backing as the country accelerates efforts to eliminate TB.
By cutting treatment duration from "9-18 months or longer to six months," the study said the regimens align with national priorities to "optimise resource utilisation and accelerate progress towards TB elimination."
The economic case for shorter, all-oral regimens is expected to play a key role in shaping future policy decisions under the NTEP, potentially marking a significant shift in India's fight against drug-resistant tuberculosis.
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