Shorter TB Regimens Reduce Costs in India: ICMR Study - Video

Six-month, all-oral treatment regimens for multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) are both cost-effective and associated with improved health outcomes compared to longer regimens currently used in India, according to an economic evaluation published in the Indian Journal of Medical Research.

The study was conducted by the ICMR–National Institute for Research in Tuberculosis and assessed the cost-effectiveness of two bedaquiline-based regimens: BPaL (bedaquiline, pretomanid, and linezolid) and BPaLM (which adds moxifloxacin). These were compared with the existing 9–11 month shorter regimen and the 18–20 month longer regimen used under India’s 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 saved INR 379 per patient compared to the current standard regimen. This indicates better health outcomes at a lower overall cost.

The BPaLM regimen was also highly cost-effective, requiring an additional expenditure of only INR 37 per patient per additional QALY gained. Both regimens were associated with lower or comparable total healthcare costs, including medication, hospital visits, and follow-up care.

MDR/RR-TB presents major challenges due to prolonged treatment duration, adverse drug effects, and high financial burden. Shorter, all-oral regimens may improve adherence, reduce complications, and allow patients to return to normal activities sooner. By reducing treatment duration to six months, these regimens support more efficient use of healthcare resources and align with India’s national TB elimination goals.

The study concludes that BPaL-based regimens are likely to be cost-saving or highly cost-effective and should be considered for broader programmatic adoption under NTEP to strengthen India’s response to drug-resistant tuberculosis.

REFERENCE: Malaisamy Muniyandi, Karikalan Nagarajan, Karthick Chelvanayagam. Kavitha Rajsekar, Kirti Tyagi, Chandrasekaran Padmapriyadarsini; Cost-effectiveness of BPaL/BPaLM as compared to mixed standard of care bedaquiline containing regimen for MDR/RR-TB; Indian Journal of Medical Research; doi: 10.25259/IJMR_158_2025