ICMR Study Backs BPaL and BPaLM Under National TB Elimination Programme
Six-month all-oral treatment regimens for multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) are not only cost-effective but also lead to better health outcomes compared to longer treatment courses currently in use, 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 (ICMR-NIRT). It evaluated the cost-effectiveness of bedaquiline-based regimens—BPaL (bedaquiline, pretomanid and linezolid) and BPaLM (with moxifloxacin)—against the existing 9–11 month shorter regimen and 18–20 month longer regimens currently implemented under the National TB Elimination Programme (NTEP).
The findings revealed that the BPaL regimen is both more effective and cost-saving. For every additional Quality Adjusted Life Year (QALY) gained, the health system spends ₹379 less per patient compared to the standard regimen, indicating improved health outcomes at reduced costs.
Similarly, the BPaLM regimen was found to be highly cost-effective. The analysis showed that it requires an additional expenditure of only ₹37 per patient for each extra QALY gained compared to the existing standard treatment approach.
Both regimens demonstrated lower or comparable overall healthcare costs, factoring in expenses related to medicines, hospital visits, monitoring, and follow-up care. The study suggests that shorter treatment duration reduces the financial and logistical burden on both patients and the healthcare system.
MDR/RR-TB presents major challenges due to prolonged therapy, significant side effects, and high treatment costs. Transitioning to six-month all-oral regimens may improve patient adherence, reduce morbidity, and enable quicker return to normal life.
By shortening treatment duration from 9–18 months or longer to just six months, these regimens align with national priorities of optimising healthcare resources and accelerating progress toward TB elimination in India.
The study concludes that BPaL-based regimens are either cost-saving or highly cost-effective and could be considered for programmatic adoption under NTEP, strengthening India’s strategy to combat drug-resistant tuberculosis.
