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, according to a study by the ICMR–National Institute for Research in Tuberculosis (ICMR-NIRT).
The study, published in the Indian Journal of Medical Research, evaluated the economic and clinical impact of bedaquiline-based regimens—BPaL (bedaquiline, pretomanid and linezolid) and BPaLM (bedaquiline, pretomanid, linezolid and moxifloxacin). These were compared with existing bedaquiline-containing shorter regimens of 9–11 months and longer regimens of 18–20 months used under the National TB Elimination Programme (NTEP).
The analysis found that the BPaL regimen was both more effective and cost-saving. For every additional quality-adjusted life year (QALY) gained, the health system spent Rs 379 less per patient compared with the standard regimen, indicating improved outcomes at a lower overall cost.
The BPaLM regimen was also assessed as highly cost-effective, with an incremental cost of Rs 37 per patient for each additional QALY gained when compared with the standard treatment. Overall healthcare costs, including medicines, hospital visits and follow-up care, were either lower or comparable for both six-month regimens.
MDR/RR-TB remains a significant public health challenge due to long treatment durations, adverse drug reactions and high treatment costs. The study noted that shorter all-oral regimens could improve treatment adherence, reduce patient morbidity and support faster recovery, while also reducing the burden on the healthcare system.
By cutting treatment duration to six months from the current 9–18 months or longer, the regimens align with national goals to optimise resources and accelerate progress towards tuberculosis elimination.
The findings suggest that BPaL-based regimens are cost-saving or highly cost-effective and could be considered for wider programmatic adoption under the NTEP to strengthen India’s response to drug-resistant TB.
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