Six-month oral regimens for drug-resistant TB found cost-effective: ICMR study

Shorter all-oral regimens can improve treatment adherence, reduce patient morbidity, and enable faster return to normal life, while also lowering the burden on the health system

A six-month, all-oral treatment for multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) is more cost-effective and delivers better health outcomes than the longer regimens currently used in India, according to an economic evaluation published in the Indian Journal of Medical Research.

MDR/RR-TB poses significant treatment challenges due to prolonged treatment duration, adverse effects, and higher costs (REPRESENTATIVE PHOTO)

The study was conducted by the ICMR–National Institute for Research in Tuberculosis (ICMR-NIRT), assessed two bedaquiline-based regimens — BPaL (bedaquiline, pretomanid and linezolid) and BPaLM (with moxifloxacin) — against the existing bedaquiline-containing shorter (9–11 months) and longer (18–20 months) regimens implemented under the National TB Elimination Programme (NTEP), said the officials in a statement released on Thursday. The study was published on December 31, 2025.

Researchers found that the BPaL regimen was both more effective and cost-saving. For each additional Quality Adjusted Life Year (QALY) gained, the health system spends ₹379 less per patient compared to the standard regimen, indicating better health outcomes at lower costs. The BPaLM regimen was also found to be highly cost-effective, with an additional expenditure of only ₹37 per patient per additional QALY gained compared to the standard regimen. Both regimens were associated with lower or comparable overall healthcare costs, including medicines, hospital visits, and follow-up care.

MDR/RR-TB poses significant treatment challenges due to prolonged treatment duration, adverse effects, and higher costs. Shorter all-oral regimens can improve treatment adherence, reduce patient morbidity, and enable faster return to normal life, while also lowering the burden on the health system.

“The findings provide important economic evidence to support the use of shorter, all-oral regimens for MDR/RR-TB management in India. By reducing treatment duration from 9–18 months or longer to six months, these regimens align with national priorities to optimise resource utilisation and accelerate progress towards TB elimination,” said the officials in the statement.

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