A recent economic evaluation published in the Indian Journal of Medical Research has concluded that a six-month all-oral treatment regimen for multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) is both cost-effective and capable of improving health outcomes compared to longer treatment courses currently employed in India. The study, carried out by the ICMR-National Institute for Research in Tuberculosis (ICMR-NIRT), was highlighted by the Ministry of Health and Family Welfare.

Comparison of New Regimens with Existing Treatments

The study focused on the cost-effectiveness of two bedaquiline-based regimens: BPaL (which includes bedaquiline, pretomanid, and linezolid) and BPaLM (which also incorporates moxifloxacin). These regimens were compared against the existing shorter (9-11 months) and longer (18-20 months) treatment options employed under the National TB Elimination Programme (NTEP).

Findings Indicate Significant Cost Savings

According to the findings, the BPaL regimen not only proves to be more effective but also results in lower healthcare costs. The analysis indicated that for each additional Quality Adjusted Life Year (QALY) gained, the healthcare system spends INR 379 less per patient compared to the standard regimen, reflecting enhanced health outcomes while minimizing expenses. The BPaLM regimen was similarly assessed to be highly cost-effective, incurring an additional cost of only INR 37 per patient for each extra QALY gained compared to the standard treatment.

Impact on Patient Care and Healthcare System

MDR/RR-TB is associated with significant treatment challenges, primarily due to the lengthy treatment period, side effects, and elevated costs. Shortening the treatment duration to an all-oral regimen enhances medication adherence, decreases patient morbidity, and facilitates a quicker return to daily activities, thereby lightening the healthcare system’s load.

Policy Implications for TB Management in India

The outcomes of this study offer crucial economic insights that support the adoption of shorter all-oral regimens for managing MDR/RR-TB within India. By reducing treatment length from the typical 9-18 months or longer to a concise six-month plan, these regimens align with national efforts to optimize resource allocation and accelerate the journey toward complete tuberculosis elimination.

Recommendations for Programmatic Adoption

The study concludes that BPaL-based regimens are likely to yield cost savings or present high cost-effectiveness, warranting consideration for programmatic implementation under the NTEP. This could significantly bolster India’s strategic response to drug-resistant tuberculosis, thus enhancing the overall effectiveness of the country’s public health initiatives against this critical issue.