India's Short Oral TB Regimens Are Cost-Effective & Superior, Study Finds
A groundbreaking economic evaluation published in the Indian Journal of Medical Research has confirmed that short-duration, all-oral treatment regimens for drug-resistant tuberculosis (TB) in India are not only highly cost-effective but also deliver superior health outcomes compared to conventional longer therapies. This research, conducted by the ICMR–National Institute for Research in Tuberculosis (ICMR-NIRT), provides robust evidence supporting the current deployment of these innovative regimens under the National Tuberculosis Elimination Programme (NTEP).
Study Focus on Six-Month Regimens
The study meticulously examined two six-month, all-oral regimens: the BPaL regimen, which combines bedaquiline, pretomanid, and linezolid, and the BPaLM regimen, which adds moxifloxacin to the mix. These regimens are specifically designed for treating multidrug-resistant and rifampicin-resistant TB (MDR/RR-TB), a form of the disease that poses significant challenges due to its resistance to standard drugs.
Findings demonstrate that these shorter regimens are both more affordable and clinically superior to the long-duration treatment protocols that have been in use. By reducing therapy time from 9–18 months or longer to just six months, they simplify treatment, reduce patient morbidity, and enable a quicker return to normal life, thereby easing the burden on India's public health system.
Cost-Effectiveness and Health Benefits
The BPaL regimen emerged as particularly effective and cost-saving. It resulted in a reduction of ₹379 per patient for every additional quality-adjusted life year (QALY) gained compared to standard treatment. This reflects improved health outcomes at a lower overall cost to the healthcare system, making it a financially prudent choice.
Similarly, the BPaLM regimen was found to be highly cost-effective. Compared to standard therapy, it required only ₹37 in additional expenditure per patient for each extra QALY gained. Overall costs related to medicines, hospital visits, and follow-up care were either lower than or comparable to those under existing regimens, highlighting its economic viability.
Aligning with National Health Priorities
MDR/RR-TB has long been a major public health concern in India, characterized by prolonged therapy duration, adverse drug effects, and high treatment costs. The introduction of these short-course, all-oral regimens addresses these issues head-on. By cutting treatment duration significantly, they align with national priorities for efficient resource utilisation and accelerate progress towards India's ambitious tuberculosis elimination goals.
The researchers concluded that BPaL-based regimens are either cost-saving or minimally cost-intensive. They can be safely adopted under the NTEP to strengthen India's response to drug-resistant TB, offering a scalable solution that benefits both patients and the healthcare infrastructure.
This study underscores the importance of innovative treatment strategies in combating drug-resistant TB. As India continues to battle this disease, the adoption of such cost-effective and superior regimens could play a pivotal role in achieving a TB-free nation, improving patient outcomes while optimizing healthcare expenditures.
