India’s economic evidence on drug-resistant tuberculosis has strengthened the case for shorter, all-oral treatment. An evaluation by ICMR–National Institute for Research in Tuberculosis found that six-month bedaquiline-based regimens for multidrug-resistant and rifampicin-resistant TB are more cost-effective than the longer regimens currently used under the National TB Elimination Programme. The study compared BPaL and BPaLM with existing shorter and longer treatment options and found better health outcomes at lower or near-comparable cost.
Key Regimens Evaluated
- BPaL includes bedaquiline, pretomanid and linezolid.
- BPaLM adds moxifloxacin to the BPaL combination.
- Both are fully oral regimens and last about six months.
- The comparison was made with current 9–11 month and 18–20 month regimens used in India.
Cost-Effectiveness Findings
- BPaL was found to be both more effective and cost-saving.
- For every additional quality-adjusted life year gained, the health system spent INR 379 less per patient than with the standard regimen.
- BPaLM was also highly cost-effective, with only INR 37 extra per patient per additional QALY gained.
- Overall healthcare costs, including medicines, hospital visits and follow-up care, were lower or comparable.
Public Health Significance
- Drug-resistant TB treatment is often long, costly and associated with adverse effects.
- Shorter all-oral regimens can improve adherence and reduce patient morbidity.
- They may also help patients return to normal life faster.
- The findings support faster progress towards TB elimination and better resource use under NTEP.
Policy Relevance For India
- The study provides economic support for programmatic adoption of BPaL-based regimens.
- It strengthens the case for shifting from prolonged treatment to shorter oral options.
- Such regimens may reduce the burden on the health system while improving outcomes for MDR/RR-TB patients.