Shorter six-month DR-TB treatment cheaper, more effective: ICMR study

An ICMR study has found that the six-month all-oral treatment regimens for multidrug-resistant and rifampicin-resistant tuberculosis are cost-effective and offer improved health outcomes compared to the longer treatment plans currently used in India.

The economic evaluation conducted by ICMR's National Institute for Research in Tuberculosis (NIRT) was published in the Indian Journal of Medical Research (IJMR).

It assessed the cost-effectiveness of the shorter bedaquiline-based regimens -- BPaL (bedaquiline, pretomanid and linezolid) and BPaLM (with moxifloxacin) -- in comparison with the nine-to-11-month and the 18-to 20-month-long bedaquiline-containing treatment plans used under the National TB Elimination Programme (NTEP).

The analysis revealed that the BPaL regimen is more effective against multidrug-resistant and rifampicin-resistant tuberculosis and, at the same time, more economical.

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 for each patient per additional QALY gained compared to the standard regimen. Both treatment plans were associated with lower or comparable overall healthcare costs, including medicines, hospital visits, and follow-up care.

Multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) poses significant 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 study found.

The analysis provides important economic evidence to support the use of shorter, all-oral regimens for MDR/RR-TB management in India. By reducing treatment duration to six months, these regimens align with national priorities to optimise resource utilisation and accelerate progress towards tuberculosis elimination.

The study concluded 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 tuberculosis.