Shorter Six-Month All-Oral MDR/RR-TB Regimens in India Prove Cost-Effective with Better Outcomes

The evaluation underscores that BPaL-based regimens are likely to be cost-saving or highly cost-effective and thus strong candidates for programmatic adoption under the NTEP.

A new economic evaluation published in the Indian Journal of Medical Research shows that innovative, shorter six-month all-oral treatment regimens for multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) are not only more effective but also cost-saving compared with the longer regimens currently used in India. Conducted by the ICMR–National Institute for Research in Tuberculosis (ICMR-NIRT), the study offers compelling evidence to accelerate adoption of bedaquiline-based regimens under India’s National TB Elimination Programme (NTEP).

Transforming MDR/RR-TB Treatment in India

The study evaluated the cost-effectiveness of two cutting-edge six-month, all-oral bedaquiline-based regimens — BPaL (bedaquiline, pretomanid and linezolid) and BPaLM (with moxifloxacin) — against the currently used shorter (9–11 months) and longer (18–20 months) bedaquiline-containing regimens. These findings have critical implications for India’s response to drug-resistant TB, a major public health challenge marked by high treatment costs, prolonged regimens and significant patient morbidity.

Key Findings: Better Health at Lower Cost

• BPaL regimen: Demonstrated both higher effectiveness and cost-savings. For every additional Quality Adjusted Life Year (QALY) gained, the health system spends INR 379 less per patient compared to the standard regimen — indicating superior health outcomes at lower costs.

• BPaLM regimen: Also highly cost-effective, with only INR 37 additional spending per patient per extra QALY gained compared with standard care.

• Overall, both BPaL and BPaLM showed lower or comparable total healthcare costs, including medication, hospital visits, and follow-up care.

Why Shorter, All-Oral Regimens Matter

MDR/RR-TB treatment has traditionally been long, complex and taxing:

• Duration: 9–20 months or longer under current regimens

• Challenges: High pill burden, injectable agents, severe side effects

• Patient impact: Lower adherence, prolonged morbidity, economic hardship

In contrast, the six-month all-oral regimens:

• Eliminate injectable agents

• Reduce treatment duration by up to 12 months or more

• Improve adherence and health outcomes

• Support faster return to work and daily life

• Reduce strain on health systems

National and Global Significance

“These results are a major step forward in the fight against drug-resistant TB,” said the study authors. “Shorter, all-oral regimens like BPaL and BPaLM can revolutionise treatment by combining clinical efficacy with economic sustainability.” With India accounting for a significant share of the global MDR/RR-TB burden, programme scale-up of these regimens could accelerate the country’s march toward TB elimination.

Programmatic Adoption Under NTEP

The evaluation underscores that BPaL-based regimens are likely to be cost-saving or highly cost-effective and thus strong candidates for programmatic adoption under the NTEP. Introducing these regimens into national protocols could:

• Optimise resource utilisation

• Strengthen TB care delivery

• Enhance patient-centred outcomes

Access the Full Study 

Journalists and researchers can review the complete economic evaluation at: https://ijmr.org.in/cost-effectiveness.pdf