Testing Isn’t Everywhere—BPaLM Can Be: The “Empiric Advantage”

For decades, people living with drug-resistant tuberculosis (DR-TB) have faced long, painful, and uncertain treatment journeys. But the rise of shorter, all-oral regimens like BPaL and BPaLM is changing that story — turning innovation into access, and access into hope. 

New Evidence from Four High-Burden Countries 

A recent study published in PLOS Global Public Health (October 2025) reinforces just how powerful that shift could be. Researchers found that using the six-month BPaLM regimen even without waiting for drug resistance test results can be highly cost-effective — especially in countries where TB burden remains high, and testing access is limited. 

The study, conducted by Chaelin Kim and colleagues, examined whether using BPaLM (bedaquiline, pretomanid, linezolid, and moxifloxacin) empirically — that is, without waiting for fluoroquinolone resistance test results — would still make sense from a public health and economic perspective. 

Researchers modeled this across four countries with high TB burdens and different testing capacities: Georgia, India, the Philippines, and South Africa. The results were striking! 

Country Results at a Glance 

Even in areas where testing isn’t available for everyone, empirically using BPaLM could still be a cost-effective and lifesaving choice: 

• India: $32 per healthy year of life gained 

• Philippines: $35 per healthy year of life gained 

• Georgia: $58 per healthy year of life gained 

• South Africa: $174 per healthy year of life gained 

All figures were well below 50% of each country’s GDP per capita — the global benchmark for cost-effectiveness. In simpler terms: BPaLM isn’t just effective — it’s affordable, impactful, and equitable. 

Bridging the Diagnostic Gap and Fast Tracking the Cure 

Currently, only about 55% of people with DR-TB worldwide receive fluoroquinolone resistance testing. That means nearly half begin treatment without knowing whether key drugs will work for them. This study provides vital evidence that we can move faster, ensuring people start the right treatment sooner, even in places where diagnostic capacity lags. 

And that’s exactly where community-led efforts like Fast Track the Cure come in. Through awareness, advocacy, and action, FTTC helps ensure that scientific breakthroughs like BPaL/M reach the people who need them most faster. Removing barriers, empowering communities, and putting people first saves times, money, and most importantly—lives!