All oral regimens for drug resistant TB are cost effective and more effective in India: ICMR study

New research indicates a significant advancement in the treatment of drug-resistant tuberculosis (TB) in India. An economic evaluation published in the Indian Journal of Medical Research demonstrates that shorter, all-oral treatment regimens are not only more affordable but also yield better health outcomes than traditional, longer-duration therapies.

Shorter Treatment, Greater Impact

The study, conducted by researchers at the ICMR–National Institute for Research in Tuberculosis (ICMR-NIRT), focused on two six-month, all-oral regimens: BPaL (bedaquiline, pretomanid and linezolid) and BPaLM (bedaquiline, pretomanid, linezolid and moxifloxacin). These regimens are currently being used as part of the National Tuberculosis Elimination Programme (NTEP) to treat multidrug-resistant and rifampicin-resistant TB (MDR/RR-TB).

Did You Know? Treatment duration for drug-resistant TB has been reduced from 9–18 months or longer to just six months with these new regimens.

The findings reveal that the BPaL regimen is both more effective and cost-saving. For every additional quality-adjusted life year (QALY) gained, there was a reduction of ₹379 per patient compared to standard treatment. The BPaLM regimen also proved highly cost-effective, requiring only ₹37 in additional expenditure per patient for each extra QALY gained.

Addressing a Critical Health Challenge

MDR/RR-TB presents substantial challenges due to lengthy treatment periods, adverse drug effects, and high costs. The introduction of these short-course, all-oral regimens simplifies treatment, reduces illness, and allows patients to return to their normal lives more quickly. This also lessens the strain on the public health system.

Expert Insight: The shift towards shorter, all-oral regimens represents a crucial step in optimizing resource allocation within India’s public health infrastructure, potentially freeing up funds for other critical healthcare initiatives.

Overall costs—including medications, hospital visits, and follow-up care—were found to be lower than or comparable to those associated with existing treatment protocols. Researchers concluded that BPaL-based regimens are either cost-saving or minimally cost-intensive and can be safely integrated into the NTEP to bolster India’s response to drug-resistant TB.

Frequently Asked Questions

What regimens were examined in the study?

The study examined two six-month, all-oral regimens: BPaL (bedaquiline, pretomanid and linezolid) and BPaLM (which additionally includes moxifloxacin).

How do these new regimens compare in cost to standard treatment?

The BPaL regimen resulted in a reduction of ₹379 per patient for every additional quality-adjusted life year (QALY) gained, while the BPaLM regimen required only ₹37 in additional expenditure per patient for each extra QALY gained, compared to standard therapy.

What is the current status of these regimens in India?

These shorter regimens are currently deployed under the National Tuberculosis Elimination Programme (NTEP) for the treatment of multidrug-resistant and rifampicin-resistant TB (MDR/RR-TB).

As these findings are implemented, it will be important to monitor their long-term impact on treatment success rates and overall public health outcomes.

All oral regimens for drug resistant TB are cost effective and more effective in India: ICMR study | Nagpur News