An economic evaluation by scientists at ICMR–National Institute for Research in Tuberculosis (NIRT) has found that newer, six-month, all-oral regimens are not only clinically effective but also financially prudent for the public health system.
Published in the Indian Journal of Medical Research (IJMR), the analysis ‘Shorter & cheaper regimen to treat multidrug-resistant tuberculosis: A new hope’ compared the widely used longer treatment schedules with compact combinations built around bedaquiline. The conclusion is striking: shorter therapy can save money while delivering better health outcomes for people with multidrug-resistant and rifampicin-resistant TB (MDR/RR-TB).
The findings come at a crucial time for India, which continues to shoulder the world’s largest tuberculosis burden. Drug-resistant disease has been particularly difficult to manage. Patients often endure nine months to nearly two years of therapy, swallowing handfuls of pills, coping with toxicities, and making repeated hospital visits, as per the experts in the sector. Many struggle to complete treatment, leading to relapse, ongoing transmission, and mounting costs.
Researchers evaluated two newer regimens — BPaL (bedaquiline, pretomanid, and linezolid) and BPaLM, which adds moxifloxacin. These combinations have drawn global attention because they remove the need for painful injections and drastically shorten therapy.
Under the government’s National TB Elimination Programme, current options include bedaquiline-containing shorter regimens lasting 9–11 months and conventional longer regimens extending up to 18–20 months. While effective, they demand enormous commitment from both patients and the health system.
Using cost and outcome modelling, the investigators estimated how much the country would spend for every additional quality-adjusted life year, a measure that captures both longer survival and better quality of life.
The BPaL regimen emerged as a rare public health win-win. For each additional QALY gained, the system would actually spend Rs. 379 less per patient than with existing standards. In economic terms, that makes it dominant — better results at lower cost, said Dr. Rajendra Prasad and Dr. Amitabh Banka from the Department of Pulmonary Medicine, ERA's Lucknow Medical College & Hospital, Lucknow, and Dr. Nikhil Gupta, Department of General Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow.
BPaLM also performed strongly. The extra investment required worked out to just Rs. 37 per additional QALY, a figure considered highly cost-effective by accepted thresholds. Importantly, overall expenditure on medicines, monitoring, hospitalisation, and follow-up remained lower or broadly similar.
Shorter therapy means fewer months of nausea, neuropathy, and fatigue. It means patients can return to work sooner, children can resume school, and families can begin to recover financially. For clinicians, it promises improved adherence and fewer instances of treatment abandonment.
Public health experts have long argued that economics must guide policy in high-burden settings.
The study’s authors suggested that adopting BPaL-based strategies programmatically could accelerate progress towards elimination goals. Shortening treatment from well over a year to six months would ease pressure on laboratories, drug supply chains, and healthcare workers, while improving patient satisfaction.
Implementation, however, will require careful planning, emphasised the authors. Training, pharmacovigilance for linezolid toxicity, and equitable access across States remain essential.
The experts said smarter regimens may help transform one of the most stubborn challenges in infectious disease control into a more manageable fight — and do so without demanding extra spending.
