{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T20:02:55Z","timestamp":1784836975177,"version":"3.55.0"},"reference-count":21,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Belarus remains a high-burden country for multidrug-\/rifampicin-resistant tuberculosis (MDR\/RR-TB), including pre-extensively drug-resistant TB (pre-XDR-TB). BPaL-based and modified 9-month short treatment regimens (mSTR), implemented under operational research conditions, have demonstrated improved clinical outcomes, but evidence on their cost-effectiveness in real-world settings remains limited. We evaluated the cost-effectiveness of BPaL-based regimens containing bedaquiline, pretomanid, and linezolid with either moxifloxacin or clofazimine (BPaL(M\/C)); mSTR composed of bedaquiline, levofloxacin, linezolid, clofazimine, cycloserine, or delamanid; and standard of care (SOC;\u2009\u2265\u200918-month regimens) for MDR\/RR-TB and pre-XDR-TB in Belarus over a 20-year horizon using a cohort-based Markov model. Clinical effectiveness, safety, and cost inputs were derived from operational research and WHO data. Health outcomes were measured in quality-adjusted life-years (QALYs), costs were expressed in 2022 USD, and both were discounted at 3% annually. Incremental costs, QALYs, and incremental net monetary benefits (INMB) were estimated. Univariate, probabilistic, and conservative scenario analyses were conducted. A scale-up analysis assessed national budgetary implications. Probabilistic sensitivity analysis showed that both shorter regimens were cost-effective compared with SOC at the Belarus-specific willingness-to-pay threshold, with mean [IQR] INMB of USD 27,586 [16,248; 37,645] for BPaL(M\/C) and USD 23,488 [10,887; 35,092] for mSTR versus SOC. In the base case, BPaL(M\/C) was the most cost-effective strategy, with lower mean costs (USD 8,155) and higher effectiveness (10.82 QALYs) than SOC (USD 20,757; 8.91 QALYs). mSTR was also cost-effective compared with SOC but less effective than BPaL(M\/C). Results were robust across sensitivity and scenario analyses. Under conservative assumptions of identical clinical outcomes, shorter regimens remained cost-saving. The scale-up analysis showed that expanding use of shorter regimens in Belarus could generate annual TB programme budget savings exceeding USD 9.8 million. BPaL(M\/C) and mSTR are cost-effective alternatives to SOC in Belarus, offering substantial economic benefits at both patient and programmatic levels.<\/jats:p>","DOI":"10.1371\/journal.pgph.0005872","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T19:10:43Z","timestamp":1784833843000},"page":"e0005872","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-effectiveness of BPaL-based and 9-month modified all-oral short treatment regimens for rifampicin-resistant tuberculosis in Belarus"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8691-1849","authenticated-orcid":true,"given":"Natalia","family":"Yatskevich","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"pgph.0005872.ref001","doi-asserted-by":"crossref","DOI":"10.54394\/CJQU6666","volume-title":"Global tuberculosis report 2024","author":"World Health Organization","year":"2024"},{"issue":"4","key":"pgph.0005872.ref002","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1093\/cid\/ciaf035","article-title":"The Effectiveness and Safety of Bedaquiline, Pretomanid, and Linezolid (BPaL)-Based Regimens for Rifampicin-Resistant Tuberculosis in Non-Trial Settings-A Prospective Cohort Study in Belarus and Uzbekistan","volume":"81","author":"A Sinha","year":"2025","journal-title":"Clin Infect Dis"},{"issue":"10","key":"pgph.0005872.ref003","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1016\/S1473-3099(24)00228-7","article-title":"Effectiveness and safety of modified fully oral 9-month treatment regimens for rifampicin-resistant tuberculosis: a prospective cohort study","volume":"24","author":"O Korotych","year":"2024","journal-title":"Lancet Infect Dis"},{"issue":"2","key":"pgph.0005872.ref004","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(24)00467-4","article-title":"24-week, all-oral regimens for pulmonary rifampicin-resistant tuberculosis in TB-PRACTECAL trial sites: an economic evaluation","volume":"13","author":"S Sweeney","year":"2025","journal-title":"Lancet Glob Health"},{"issue":"8","key":"pgph.0005872.ref005","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1016\/j.jval.2016.04.015","article-title":"The International Decision Support Initiative Reference Case for Economic Evaluation: An Aid to Thought","volume":"19","author":"T Wilkinson","year":"2016","journal-title":"Value Health"},{"issue":"2","key":"pgph.0005872.ref006","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/S2213-2600(23)00389-2","article-title":"Short oral regimens for pulmonary rifampicin-resistant tuberculosis (TB-PRACTECAL): an open-label, randomised, controlled, phase 2B-3, multi-arm, multicentre, non-inferiority trial","volume":"12","author":"B-T Nyang\u2019wa","year":"2024","journal-title":"Lancet Respir Med"},{"key":"pgph.0005872.ref007","volume-title":"WHO consolidated guidelines on drug-resistant tuberculosis treatment","year":"2019"},{"key":"pgph.0005872.ref008","volume-title":"Module 4: treatment - drug-resistant tuberculosis treatment, 2022 update","author":"WHO consolidated guidelines on tuberculosis","year":"2022"},{"key":"pgph.0005872.ref009","unstructured":"World Bank. 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