Comparing BPaL and BPaLM Regimens
Researchers assessed bedaquiline-based combinations BPaL (bedaquiline, pretomanid and linezolid) and BPaLM (with the addition of moxifloxacin). These regimens are entirely oral, eliminating the need for injectable drugs that are often associated with severe side effects.
The analysis revealed that the BPaL regimen delivers better outcomes at a lower cost. For every additional Quality Adjusted Life Year (QALY) gained, the health system saves ₹379 per patient compared to the standard regimen. This means patients not only live healthier lives but the healthcare system also spends less.
The BPaLM regimen was also found to be highly cost-effective. It requires an additional expenditure of just ₹37 per patient per extra QALY gained, making it an economically viable alternative within India’s public health framework.
Reducing Burden on Patients and Health System
Drug-resistant TB remains one of India’s most pressing public health challenges. Long treatment durations—sometimes extending up to 20 months—often lead to poor adherence, adverse reactions, and significant financial strain on families.
Shortening treatment to six months can significantly reduce patient suffering and improve compliance. Fewer hospital visits, reduced monitoring requirements, and lower medicine costs collectively decrease the burden on the healthcare infrastructure.
The study noted that overall healthcare expenses—including medicines, follow-up consultations, and hospitalisation—were either lower or comparable in the shorter regimens. This aligns with India’s broader objective of optimising health resources while accelerating TB elimination.
Boost to India’s TB Elimination Goal
India has set an ambitious target of eliminating tuberculosis ahead of the global 2030 Sustainable Development Goal timeline. Evidence-backed interventions are critical to achieving this milestone.
The ICMR findings provide strong economic justification for scaling up six-month all-oral regimens under the NTEP. By reducing treatment duration and improving health outcomes, these regimens can accelerate progress toward a TB-free India.
Policy Implications
The study concludes that BPaL-based regimens are either cost-saving or highly cost-effective and may be considered for wider programmatic adoption. Policymakers now have robust financial evidence to support integrating these regimens into routine practice.
As India continues to shoulder the highest TB burden globally, innovations that are clinically effective and economically sustainable will play a decisive role in transforming public health outcomes.
