{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T05:54:13Z","timestamp":1780466053020,"version":"3.54.1"},"reference-count":22,"publisher":"Scientific Scholar","content-domain":{"domain":["ijmr.org.in"],"crossmark-restriction":true},"short-container-title":["Indian J Med Res"],"abstract":"<jats:sec>\n                    <jats:title>Background &amp; objectives<\/jats:title>\n                    <jats:p>Current options for treating tuberculosis (TB) that is resistant to rifampicin (RR-TB) are limited and available regimens are often lengthy and poorly tolerated. However, following recent evidence from the TB PRACTECAL trial, countries are considering programmatic adoption of six-month, all-oral treatment regimen such as bedaquiline, pretomanid, linezolid (BPaL) and BPaL with moxifloxacin (BPaLM). We conducted an economic evaluation to assess whether the introduction of BPaL\/BPaLM regimen under National Tuberculosis Elimination Programme (NTEP) for the treatment of multi-drug resistant (MDR)\/RR-TB is a cost-effective strategy. The idea was to estimate the incremental cost incurred from BPaL\/BPaLM regimen in comparison with the current mix of standard of care (SoC) regimen.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used an economic model comprising a Markov analysis. The study estimated the incremental costs, life years gained and quality adjusted life years (QALYs) gained by the introduction of BPaL\/BPaLM regimen for MDR\/RR-TB patients. A scenario analysis for different proportions of shorter and longer SoC regimen compared with BPaL\/BPaLM was also done. Cost threshold analysis was done to assess the ideal cost at which the drug BPaL\/BPaLM turns into cost-saving. Budget impact analysis was conducted to assess the financial implications of adopting BPaL\/BPaLM compared to mix SoC, supporting informed decision-making alongside cost-effectiveness analysis for one year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The base case analysis showed the total discounted costs by health system perspective for the BPaL, BPaLM and the current mixed SoC were INR 2515, INR 2644 and INR 2630 million, respectively. The ICER for BPaL was INR -379 which indicates that we have to spend INR 379 less per patient for BPaL than the mixed SoC to gain one QALY. The ICER for BPaLM was INR 37 which indicates that we have to spend INR 37 additionally per patient for BPaLM than the mixed SoC to gain one QALY.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation &amp; conclusions<\/jats:title>\n                    <jats:p>Our findings indicate that BPaL based regimens are likely to be cost-saving and more effective than the current mixed SoC in a range of settings. Countries should consider programmatic uptake of BPaL based regimens to treat MDR\/RR-TB.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.25259\/ijmr_158_2025","type":"journal-article","created":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T14:40:54Z","timestamp":1767278454000},"page":"581-591","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cost-effectiveness of BPaL\/BPaLM as compared to mixed standard of care bedaquiline containing regimen for MDR\/RR-TB"],"prefix":"10.25259","volume":"162","author":[{"given":"Malaisamy","family":"Muniyandi","sequence":"first","affiliation":[{"name":"Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karikalan","family":"Nagarajan","sequence":"additional","affiliation":[{"name":"Department of Socio-Behavioural Research, ICMR-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karthick","family":"Chelvanayagam","sequence":"additional","affiliation":[{"name":"Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavitha","family":"Rajsekar","sequence":"additional","affiliation":[{"name":"Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirti","family":"Tyagi","sequence":"additional","affiliation":[{"name":"Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chandrasekaran","family":"Padmapriyadarsini","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2025,12,31]]},"reference":[{"key":"10.25259\/IJMR_158_2025\/ref-1","doi-asserted-by":"publisher","first-page":"675","DOI":"10.21037\/qims-21-290","article-title":"Differentiating between drug-sensitive and drug-resistant tuberculosis with machine learning for clinical and radiological features","volume":"12","author":"Yang","year":"2022","journal-title":"Quant Imaging Med Surg"},{"key":"10.25259\/IJMR_158_2025\/ref-2","doi-asserted-by":"publisher","first-page":"e0001337","DOI":"10.1371\/journal.pgph.0001337","article-title":"Cost-effectiveness of short, oral treatment regimens for rifampicin resistant tuberculosis","volume":"2","author":"Sweeney","year":"2022","journal-title":"PLOS Glob Public Health"},{"key":"10.25259\/IJMR_158_2025\/ref-4","doi-asserted-by":"publisher","first-page":"e051521","DOI":"10.1136\/bmjopen-2021-051521","article-title":"Cost-effectiveness of bedaquiline, pretomanid and linezolid for treatment of extensively drug-resistant tuberculosis in South Africa, Georgia and the Philippines","volume":"11","author":"Gomez","year":"2021","journal-title":"BMJ Open"},{"key":"10.25259\/IJMR_158_2025\/ref-6","doi-asserted-by":"publisher","first-page":"55","DOI":"10.3390\/jcm9010055","article-title":"Short-course regimen for multidrug-resistant tuberculosis: a decade of evidence","volume":"9","author":"Tr\u00e9bucq","year":"2019","journal-title":"J Clin Med"},{"key":"10.25259\/IJMR_158_2025\/ref-7","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1183\/16000617.0080-2015","article-title":"Short-course treatment for multidrug-resistant tuberculosis: The STREAM trials","volume":"25","author":"Moodley","year":"2016","journal-title":"Eur Respir Rev"},{"key":"10.25259\/IJMR_158_2025\/ref-8","doi-asserted-by":"publisher","first-page":"1201","DOI":"10.1056\/NEJMoa1811867","article-title":"A trial of a shorter regimen for rifampin-resistant tuberculosis","volume":"380","author":"Nunn","year":"2019","journal-title":"N Engl J Med"},{"key":"10.25259\/IJMR_158_2025\/ref-9","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1186\/s12879-021-05870-w","article-title":"Refining MDR-TB treatment regimens for ultra short therapy (TB-TRUST): Study protocol for a randomized controlled trial","volume":"21","author":"Weng","year":"2021","journal-title":"BMC Infect Dis"},{"key":"10.25259\/IJMR_158_2025\/ref-11","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1056\/NEJMoa1901814","article-title":"Treatment of highly drug-resistant pulmonary tuberculosis","volume":"382","author":"Conradie","year":"2020","journal-title":"N Engl J Med"},{"key":"10.25259\/IJMR_158_2025\/ref-12","doi-asserted-by":"publisher","first-page":"810","DOI":"10.1056\/NEJMoa2119430","article-title":"Bedaquiline-pretomanid-linezolid regimens for drug-resistant tuberculosis","volume":"387","author":"Conradie","year":"2022","journal-title":"N Engl J Med"},{"key":"10.25259\/IJMR_158_2025\/ref-13","doi-asserted-by":"publisher","first-page":"2331","DOI":"10.1056\/NEJMoa2117166","article-title":"A 24-week, all-oral regimen for rifampin-resistant tuberculosis","volume":"387","author":"Nyang\u2019wa","year":"2022","journal-title":"N Engl J Med"},{"key":"10.25259\/IJMR_158_2025\/ref-15","doi-asserted-by":"publisher","first-page":"220","DOI":"10.4103\/ijmr.ijmr_300_23","article-title":"Optimal management of drug-resistant tuberculosis: Can India lead the way?","volume":"157","author":"Masini","year":"2023","journal-title":"Indian J Med Res"},{"key":"10.25259\/IJMR_158_2025\/ref-17","doi-asserted-by":"publisher","first-page":"3388","DOI":"10.4103\/jfmpc.jfmpc_409_19","article-title":"Epidemiological profile of tuberculosis patients in Delhi, India: A retrospective data analysis from the directly observed treatment short-course (DOTS) center","volume":"8","author":"Sharma","year":"2019","journal-title":"J Family Med Prim Care"},{"key":"10.25259\/IJMR_158_2025\/ref-18","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1093\/heapol\/czz127","article-title":"On discount rates for economic evaluations in global health","volume":"35","author":"Haacker","year":"2020","journal-title":"Health Policy Plan"},{"key":"10.25259\/IJMR_158_2025\/ref-21","doi-asserted-by":"publisher","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":"Nyang\u2019wa","year":"2024","journal-title":"Lancet Respir Med"},{"key":"10.25259\/IJMR_158_2025\/ref-22","doi-asserted-by":"publisher","first-page":"100408","DOI":"10.1016\/j.jctube.2023.100408","article-title":"The use of BPaL containing regimen in the MDR\/PreXDR TB treatments in Thailand","volume":"34","author":"Sangsayunh","year":"2023","journal-title":"J Clin Tuberc Other Mycobact Dis"},{"key":"10.25259\/IJMR_158_2025\/ref-23","doi-asserted-by":"publisher","first-page":"453","DOI":"10.5588\/ijtld.21.0035","article-title":"Pretomanid with bedaquiline and linezolid for drug-resistant TB: a comparison of prospective cohorts","volume":"25","author":"Oelofse","year":"2021","journal-title":"Int J Tuberc Lung Dis"},{"key":"10.25259\/IJMR_158_2025\/ref-24","doi-asserted-by":"publisher","first-page":"599","DOI":"10.5588\/ijtld.22.0649","article-title":"Favourable outcomes in RR-TB patients using BPaL and other WHO-recommended second-line anti-TB drugs","volume":"27","author":"Rikhotso","year":"2023","journal-title":"Int J Tuberc Lung Dis"},{"key":"10.25259\/IJMR_158_2025\/ref-25","doi-asserted-by":"publisher","first-page":"1042","DOI":"10.1016\/S1473-3099(21)00811-2","article-title":"Treatment outcomes 24 months after initiating short, all-oral bedaquiline-containing or injectable-containing rifampicin-resistant tuberculosis treatment regimens in South Africa: a retrospective cohort study","volume":"22","author":"Ndjeka","year":"2022","journal-title":"Lancet Infect Dis"},{"key":"10.25259\/IJMR_158_2025\/ref-26","doi-asserted-by":"publisher","first-page":"1131","DOI":"10.1111\/j.1524-4733.2008.00352.x","article-title":"Deriving an algorithm to convert the eight mean SF-36 dimension scores into a mean EQ-5D preference-based score from published studies (where patient level data are not available)","volume":"11","author":"Ara","year":"2008","journal-title":"Value Health"},{"key":"10.25259\/IJMR_158_2025\/ref-27","doi-asserted-by":"publisher","first-page":"283","DOI":"10.4314\/mmj.v30i4.12","article-title":"Health-Related Quality of Life (HRQoL) scores vary with treatment and may identify potential defaulters during treatment of tuberculosis","volume":"30","author":"Olufemi","year":"2018","journal-title":"Malawi Med J"},{"key":"10.25259\/IJMR_158_2025\/ref-29","doi-asserted-by":"publisher","first-page":"e007182","DOI":"10.1136\/bmjgh-2021-007182","article-title":"Budgetary impact of using BPaL for treating extensively drug-resistant tuberculosis","volume":"7","author":"Mulder","year":"2022","journal-title":"BMJ Glob Health"},{"key":"10.25259\/IJMR_158_2025\/ref-30","doi-asserted-by":"publisher","first-page":"81","DOI":"10.5588\/ijtld.23.0163","article-title":"Cost-effectiveness of pretomanid-based regimen for highly drugresistant TB in a low-burden setting","volume":"28","author":"Fekadu","year":"2024","journal-title":"Int J Tuberc Lung Dis"}],"container-title":["The Indian Journal of Medical Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/ijmr.org.in\/cost-effectiveness-of-bpal-bpalm-as-compared-to-mixed-standard-of-care-bedaquiline-containing-regimen-for-mdr-rr-tb\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/ijmr.org.in\/cost-effectiveness-of-bpal-bpalm-as-compared-to-mixed-standard-of-care-bedaquiline-containing-regimen-for-mdr-rr-tb\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T14:40:55Z","timestamp":1767278455000},"score":1,"resource":{"primary":{"URL":"http:\/\/ijmr.org.in\/cost-effectiveness-of-bpal-bpalm-as-compared-to-mixed-standard-of-care-bedaquiline-containing-regimen-for-mdr-rr-tb\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,31]]},"references-count":22,"alternative-id":["10.25259\/IJMR_158_2025"],"URL":"https:\/\/doi.org\/10.25259\/ijmr_158_2025","relation":{},"ISSN":["0971-5916"],"issn-type":[{"value":"0971-5916","type":"print"}],"subject":[],"published":{"date-parts":[[2025,12,31]]},"article-number":"581"}}