BPaL Regimen for Multidrug-Resistant Tuberculosis in Indonesia: Cost-Effectiveness and Efficacy Analysis

Background Multidrug-resistant tuberculosis (MDR-TB) imposes a substantial economic burden on Indonesia, with 29,600 cases in 2023 costing US$7,000–11,000 per patient for conventional 18–24-month regimens at 59% efficacy. The six-month Bedaquiline-Pretomanid-Linezolid (BPaL) regimen, endorsed by WHO, offers > 80% efficacy in trials, yet real-world cost-effectiveness data in low- and middle-income countries (LMICs) like Indonesia are limited. Objectives To evaluate BPaL’s cost-effectiveness and resource allocation implications in Indonesia, focusing on economic efficiency and policy integration for MDR-TB control. Methods A retrospective cohort study (2021–2024) at Persahabatan Hospital, Jakarta, analyzed 84 patients with MDR-TB, rifampicin-resistant TB (RR-TB), or pre-extensively drug-resistant TB (pre-XDR-TB). Costs included direct (medications, diagnostics, hospitalization) and indirect (productivity losses, transportation) expenses, compared with historical controls (2018–2020). Efficacy was defined per WHO guidelines. Incremental cost-effectiveness ratio (ICER) analyses, chi-square tests, and multivariate logistic regression assessed outcomes, with sensitivity analyses ensuring robustness. Results BPaL reduced costs by 67% (US$2,310 vs. US$7,000–11,000) with an ICER of US$311.4 per additional treatment success, achieving 77.4% efficacy (65/84 patients) versus 59% for controls (p < 0.01). Sensitivity analyses confirmed robustness. Conclusion BPaL’s superior cost-effectiveness optimizes resource allocation for MDR-TB in Indonesia, supporting integration into national guidelines and universal health coverage (JKN). This model offers scalable economic insights for LMICs, aligning with WHO’s End TB 2030 goals.