A new economic evaluation has added powerful evidence to the already strong case for wide, global adoption of BPaL and BPaL/M regimens for the treatment of drug-resistant tuberculosis (DR-TB). This study, which focuses on India, was conducted by researchers at the ICMR–National Institute for Research in Tuberculosis. It compared seven short-course treatment regimens—including BPaL/M and several variations of BPaL—to the 9-11 current standard of care (SoC). The findings show that BPaL-based regimens not only improve health outcomes but do so cost-effectively compared with national economic benchmarks.
A “Dominant” Result
The study focused on health system costs and measured outcomes using both Quality-Adjusted Life Years (QALYs) and Incremental Cost-Effectiveness Ratios (ICERs). All BPaL-based regimens showed improved effectiveness over the current SoC regimen and had ICERs well below India’s willingness-to-pay (WTP) threshold, which is based on the country’s per capita GDP (₹124,600 or approximately $1,500).
The most efficient intervention among the short-course regimens evaluated was a dosing scheme of BPaL, identified in the study as “mBPaL2.” This regimen was not only more effective but also less costly — a distinction which, in health economic terms, renders the approach “dominant.”
These figures stand in stark contrast to the SoC, which incurred higher overall costs and delivered fewer QALYs. All of the short-course regimens evaluated (several dosing variations of BPaL, BPaL/M, BPaLC, and the BEAT-TB regimen) registered far below the WTP threshold and, therefore, cost-effective from a public health financing perspective. This finding further supports the axiom that continued shortening and simplification of treatment defines the path toward improved health outcomes and cost effectiveness.
Impact on People Receiving Treatment
The study’s conclusions echo other international research showing that BPaL-based regimens not only improve treatment outcomes but also reduce the burden of disability. However, it is important to note that this study evaluated cost-effectiveness solely from the health system’s point of view. Researchers pointed out that including patient-level costs would make the economic case for shorter regimens even stronger, as previous research has also found cost-savings associated with BPaL-based treatments for those receiving treatments.
Opportunities and India and Beyond
India bears the world’s largest burden of DR-TB, and at 46% its treatment success rate for MDR-TB remains far too low, below the global benchmark of 63%. In this context, the study’s findings bolster the rationale for India—and other high-burden countries—to expand and accelerate the use of BPaL-based regimens, which have often showed treatment success rates of 90% or higher.
As the world, including India, moves forward with its TB elimination goals, the widespread implementation of cost-effective, shorter, and patient-friendly treatment regimens will be essential to success. This study offers compelling health- and economic-based evidence to support that shift.