**Executive Summary**
The Indian Council of Medical Research (ICMR) study published on February 12, 2026, evaluates the cost-effectiveness of shorter, six-month all-oral treatment regimens for multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) in India. It found that bedaquiline-based regimens (BPaL and BPaLM) are cost-effective compared to existing longer regimens used under the National TB Elimination Programme (NTEP). The study suggests programmatic adoption of BPaL-based regimens may be considered to strengthen India's response to drug-resistant TB.
**Key Points / Main Content**
* **Study Objective:** Assesses the cost-effectiveness of bedaquiline-based regimens (BPaL and BPaLM) for MDR/RR-TB compared to existing shorter (9-11 months) and longer (18–20 months) regimens under NTEP.
* **Cost-Effectiveness Findings:**
* The BPaL regimen is more effective and cost-saving; the health system spends INR 379 less per patient per Quality Adjusted Life Year (QALY) gained compared to the standard regimen.
* The BPaLM regimen is also cost-effective, with an additional expenditure of only INR 37 per patient per additional QALY gained.
* Both regimens were associated with lower or comparable overall healthcare costs.
* **Benefits of Shorter Regimens:**
* Shorter regimens improve treatment adherence and reduce patient morbidity.
* Enable faster return to normal life.
* Lower the burden on the health system.
* **Conclusion:** The study concludes that BPaL-based regimens are likely to be cost-saving or highly cost-effective.
**Impact Analysis**
**National TB Elimination Programme (NTEP)**
* **Impact:** NTEP could improve outcomes and optimize resource utilization by adopting shorter, all-oral BPaL-based regimens for MDR/RR-TB treatment.
* **Action Required:** Consider programmatic adoption of BPaL-based regimens to strengthen the response to drug-resistant TB in India.
**Patients with MDR/RR-TB**
* **Impact:** Patients may benefit from shorter treatment duration, improved adherence, reduced morbidity, and faster return to normal life.
* **Action Required:** Adhere to the prescribed shorter all-oral treatment regimens if recommended by healthcare providers.
**Healthcare System in India**
* **Impact:** The healthcare system can reduce overall healthcare costs including medicines, hospital visits, and follow-up care, by adopting shorter all-oral regimens.
* **Action Required:** Implement shorter all-oral regimens, to improve patient care and optimize the use of available resources.
Key Entities Referenced
National TB Elimination Programme (NTEP): The national program in India under which the existing TB treatment regimens are being implemented and under which the BPaL-based regimens are proposed for programmatic adoption.
Indian Journal of Medical Research: The journal where the economic evaluation of the shorter all-oral regimens for drug-resistant TB was published.
ICMR-National Institute for Research in Tuberculosis (ICMR-NIRT): The research institute that conducted the study assessing the cost-effectiveness of bedaquiline-based regimens for treating drug-resistant TB.
BPaL: A shorter all-oral regimen (bedaquiline, pretomanid, and linezolid) for treating multidrug-resistant TB, found to be cost-effective in the study.
BPaLM: A shorter all-oral regimen (bedaquiline, pretomanid, linezolid, and moxifloxacin) for treating multidrug-resistant TB, found to be cost-effective in the study.
Ministry of Health and Family Welfare
Shorter All-Oral Regimens for Drug-Resistant TB
are Cost-Effective in India: ICMR Study
Posted On: 12 FEB 2026 10:36AM by PIB Delhi
An economic evaluation published in the Indian Journal of Medical Research has demonstrated that
shorter, six-month all-oral treatment regimens for multidrug-resistant and rifampicin-resistant tuberculosis
(MDR/RR-TB) are cost-effective and offer improved health outcomes compared to the currently used
longer regimens in India.
The study was conducted by ICMR–National Institute for Research in Tuberculosis (ICMR-NIRT). It
assessed the cost-effectiveness of bedaquiline-based regimens—BPaL (bedaquiline, pretomanid and
linezolid) and BPaLM (with moxifloxacin)—in comparison with the existing bedaquiline-containing
shorter (9–11 months) and longer (18–20 months) treatment regimens used under the National TB
Elimination Programme (NTEP).
The analysis revealed that the BPaL regimen is both more effective and cost-saving. For each additional
Quality Adjusted Life Year (QALY) gained, the health system spends INR 379 less per patient compared
to the standard regimen, indicating better health outcomes at lower costs.The BPaLM regimen was also
found to be highly cost-effective, with an additional expenditure of only INR 37 per patient per additional
QALY gained compared to the standard regimen. Both regimens were associated with lower or
comparable overall healthcare costs, including medicines, hospital visits, and follow-up care.
MDR/RR-TB poses significant treatment challenges due to prolonged treatment duration, adverse effects,
and higher costs. Shorter all-oral regimens can improve treatment adherence, reduce patient morbidity,
and enable faster return to normal life, while also lowering the burden on the health system. The findings
provide important economic evidence to support the use of shorter, all-oral regimens for MDR/RR-TB
management in India. By reducing treatment duration from 9–18 months or longer to six months, these
regimens align with national priorities to optimise resource utilisation and accelerate progress towards TB
elimination.
The study concludes that BPaL-based regimens are likely to be cost-saving or highly cost-effective and
may be considered for programmatic adoption under the NTEP to strengthen India’s response to drug-
resistant TB. The full study can be accessed at: https://ijmr.org.in/cost-effectiveness.pdf
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