ICMR Study Confirms Six-Month Oral TB Regimens Reduce Costs While Improving Outcomes for Drug-Resistant Cases
Key Insights
The Indian Council of Medical Research found that six-month all-oral BPaL and BPaLM regimens for multidrug-resistant tuberculosis (search) are more cost-effective than traditional 9-20 month treatments.
The BPaL regimen saves Rs 379 per patient for each quality-adjusted life year gained compared to standard care, while BPaLM adds only Rs 37 per additional QALY.
These shorter regimens eliminate painful injections, reduce treatment duration from up to 20 months to six months, and improve patient adherence rates.
A comprehensive economic evaluation by the Indian Council of Medical Research (ICMR) has demonstrated that six-month all-oral treatment regimens for multidrug-resistant and rifampicin-resistant tuberculosis (search) deliver superior clinical outcomes while reducing healthcare costs compared to conventional longer treatments currently used in India.
Economic Analysis Reveals Significant Cost Savings
The National Institute for Research in Tuberculosis (NIRT) conducted the economic evaluation, published in the Indian Journal of Medical Research, comparing shorter bedaquiline-based regimens against standard care protocols under the National TB Elimination Programme (NTEP). The analysis assessed the BPaL regimen (bedaquiline, pretomanid and linezolid) and BPaLM regimen (with added moxifloxacin) against traditional nine-to-11-month and 18-to-20-month bedaquiline-containing treatment plans.
The BPaL regimen demonstrated remarkable cost-effectiveness, with the health system spending Rs 379 less per patient for each additional quality-adjusted life year (QALY) gained compared to standard regimens. The BPaLM regimen proved equally compelling, requiring only an additional Rs 37 per patient per additional QALY gained. Both treatment plans showed lower or comparable overall healthcare costs, including medicines, hospital visits, and follow-up care.
Clinical Advantages Drive Treatment Transformation
Traditional treatments for drug-resistant tuberculosis (search) present significant challenges, often lasting up to 20 months and requiring painful injections that contribute to high dropout rates and severe side effects. The all-oral BPaL-based therapies eliminate injection requirements while reducing treatment duration to just six months.
This transformation addresses critical adherence issues associated with multidrug-resistant and rifampicin-resistant tuberculosis (search) (MDR/RR-TB). The shorter duration enables patients to return to normal life and work much sooner, while faster recovery reduces the overall disease burden on communities. The study found that these regimens improve treatment adherence, reduce patient morbidity, and lower the burden on the health system.
Supporting National Elimination Strategy
The ICMR analysis provides crucial economic evidence supporting the integration of shorter all-oral regimens into India's tuberculosis (search) elimination strategy. By optimizing resource utilization, these regimens align with national priorities to accelerate progress toward tuberculosis elimination while managing more patients effectively within existing healthcare infrastructure.
The study concluded that BPaL-based regimens are likely to be cost-saving or highly cost-effective and recommended their consideration for programmatic adoption under the NTEP. This evidence-based approach supports scaling up these interventions to strengthen India's response to drug-resistant tuberculosis (search) while advancing toward the goal of a TB-free India.