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BPaL and BPaLM Therapies Outperform Conventional 9–20 Month Treatments in Cost and Outcomes
Anytime News Network. In a significant development for India’s fight against drug-resistant tuberculosis (MDR/RR-TB), a new economic evaluation published in the Indian Journal of Medical Research has found that six-month, all-oral treatment regimens are more cost-effective and deliver better health outcomes compared to the currently used longer-duration therapies.
The study, conducted by the ICMR–National Institute for Research in Tuberculosis (ICMR-NIRT), assessed the cost-effectiveness of bedaquiline-based short-course regimens—BPaL (Bedaquiline, Pretomanid, and Linezolid) and BPaLM (with Moxifloxacin)—against the existing 9–11 month and 18–20 month treatment regimens implemented under the National TB Elimination Programme (NTEP).
According to the analysis, the BPaL regimen was found to be cost-saving. For every additional Quality-Adjusted Life Year (QALY) gained, the health system saves ₹379 per patient compared to the standard regimen. This indicates that the therapy not only improves patient health outcomes but also reduces overall healthcare expenditure.
The BPaLM regimen was also found to be highly cost-effective. It requires only an additional ₹37 per patient per QALY gained compared to the standard therapy—an incremental cost considered minimal in health economics. Importantly, the overall healthcare costs—including drug expenses, hospital visits, and follow-up care—were either lower or comparable to the existing longer regimens.
Treatment of MDR/RR-TB has traditionally been associated with prolonged therapy, severe side effects, high costs, and lower treatment adherence. Experts believe that a shorter, fully oral six-month regimen can significantly improve patient compliance, reduce adverse effects, lower morbidity, and enable patients to return to normal life sooner. Additionally, it can ease the burden on India’s public health system.
The study provides strong economic evidence supporting the programmatic adoption of BPaL-based regimens under NTEP. Reducing treatment duration from 9–18 months or longer to just six months aligns with India’s national priorities of optimizing healthcare resources and accelerating progress toward TB elimination.
With India bearing one of the highest burdens of drug-resistant TB globally, the findings could mark a turning point in treatment strategy. Policymakers may now consider scaling up these shorter oral regimens to strengthen the country’s response to MDR/RR-TB.
🔗 Full study available at: https://ijmr.org.in/cost-effectiveness.pdf
