In a major breakthrough for global health, recent research from the Indian Council of Medical Research (ICMR)–National Institute for Research in Tuberculosis (NIRT) has found that shorter, six-month all-oral treatment regimens for multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) not only deliver better patient outcomes but also cost significantly less than traditional long-term therapies. This development could reshape how drug-resistant TB is managed, particularly in high-burden countries.
The study, published in the Indian Journal of Medical Research, analysed the cost-effectiveness of two newer regimens — BPaL (bedaquiline, pretomanid and linezolid) and BPaLM (which adds moxifloxacin) — compared with the existing shorter (9–11 months) and much longer (18–20 months) bedaquiline-containing schedules currently recommended under India’s National TB Elimination Programme (NTEP).
A key finding from the economic evaluation was that the BPaL regimen was both more effective and cost-saving compared with the standard care. For every additional quality-adjusted life year (QALY) gained — a measure that combines the length and quality of life — the health system spends about ₹379 less per patient under the six-month regimen than under existing therapies. The BPaLM variant also proved highly cost-effective, with only a small additional expenditure per QALY when compared with standard treatment, while still offering faster and safer care.
These shorter, all-oral regimens represent a dramatic shift from earlier treatments that often involved painful injectable drugs and long durations extending up to nearly two years. Such extended treatment schedules have historically contributed to low adherence levels, severe side effects, high costs, and an overall burden on both patients and healthcare systems. By reducing the treatment period to just six months and eliminating injections, the new protocols can improve patient compliance, decrease side-effect risk, and shorten the period during which patients remain infectious.
Improved adherence is crucial in tackling drug-resistant forms of TB because non-completion of treatment has been a persistent problem with longer regimens, often leading to further resistance and ongoing transmission in communities. The study’s authors emphasised that these results not only support better clinical outcomes but also offer substantial economic benefits by cutting overall healthcare costs — including medication expenses, hospital visits, and follow-up care.
The implications extend beyond direct cost savings. Because patients can complete treatment faster and with fewer complications, they are more likely to return to normal life, work and activity sooner, reducing indirect economic losses that families and societies experience due to prolonged illness. Shorter treatment also lessens the load on healthcare facilities, freeing up resources for other critical needs.
Public health experts see this development as aligned with global priorities to accelerate the elimination of tuberculosis, particularly in countries that bear a disproportionate share of the global disease burden. India, for example, accounts for a large number of MDR/RR-TB cases each year and has been at the forefront of implementing innovative strategies within its NTEP framework to optimize outcomes and resource use.
The ICMR study’s findings provide strong economic evidence for programmatic adoption of the six-month all-oral regimens under national TB programmes like India’s NTEP. Adopting these shorter treatments more widely could help health authorities reduce morbidity and mortality associated with drug-resistant TB while managing costs more sustainably, particularly in resource-limited settings.
Experts believe that these advances — when coupled with better diagnostic access, patient support systems and public health infrastructure — could help reshape the battle against one of the world’s deadliest infectious diseases. As global health organisations continue updating guidelines, the momentum for shorter, safer and more cost-effective TB therapies is gaining traction, offering hope for millions of patients worldwide.
