ArticlePLOS global public health2026
Cost-effectiveness of BPaL-based and 9-month modified all-oral short treatment regimens for rifampicin-resistant tuberculosis in Belarus.
Article in PLOS global public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
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; ≥ 18-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.
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