Shorter All-Oral Regimens for Drug-Resistant TB are Cost-Effective in India: ICMR Study

1. At a Glance

ICMR-NIRT economic evaluation in the Indian Journal of Medical Research found six-month all-oral BPaL/BPaLM regimens cost-effective vs. existing longer MDR/RR-TB regimens under NTEP [S1].
Relevant for UPSC under GS-II (Health) and GS-III (S&T) — links India's End TB 2025 target, Health Technology Assessment, and antimicrobial resistance.

12 Feb 2026 PIB release on ICMR-NIRT cost-effectiveness study supporting programmatic scale-up of BPaL/BPaLM under NTEP [S1].
Follows 2024 MoHFW approval of BPaLM as the new MDR-TB regimen [S2].

RNTCP (1997) → renamed National TB Elimination Programme (NTEP) in 2020 with the target to end TB by 2025, five years ahead of SDG 3.3 [S3].
Pradhan Mantri TB Mukt Bharat Abhiyaan launched by President Droupadi Murmu on 9 Sep 2022 [S4].
2024: MoHFW approved BPaLM (Bedaquiline + Pretomanid + Linezolid + Moxifloxacin) — endorsed after Health Technology Assessment by Department of Health Research [S2].
100-Day TB Elimination Campaign launched in Dec 2024 [S3].

Conducting body: ICMR–National Institute for Research in Tuberculosis (ICMR-NIRT), Chennai [S1].
Parent ministry: Ministry of Health & Family Welfare; research arm — Department of Health Research / ICMR [S2].
Programme: National TB Elimination Programme (NTEP) [S1][S2].
Regimens compared:
BPaL = Bedaquiline + Pretomanid + Linezolid (6 months)
BPaLM = BPaL + Moxifloxacin (6 months)
vs. existing bedaquiline-containing shorter (9–11 months) and longer (18–20 months) regimens [S1].
Key cost-effectiveness number: BPaLM = additional INR 37 per patient per additional QALY gained; BPaL = cost-saving and more effective [S2].
MDR/RR-TB burden cited: ~75,000 drug-resistant TB patients in India to benefit [S2].
Publication: Indian Journal of Medical Research (IJMR) [S1].

Economic: Incremental cost ratio (₹37/QALY for BPaLM; cost-saving for BPaL) far below India's per-capita GDP willingness-to-pay threshold → strong fiscal case for NTEP adoption [S2]. Shorter regimens reduce catastrophic out-of-pocket health expenditure.
Scientific/Technological: All-oral elimination of injectables (kanamycin/capreomycin); Pretomanid is a nitroimidazole; Bedaquiline is a diarylquinoline — both novel anti-TB classes [S2].
Social: 6-month vs 18-20 month treatment improves adherence, reduces stigma, lowers work-day loss; vital for poor and tribal patients with high TB burden [S2].
Administrative/Governance: Demonstrates Health Technology Assessment India (HTAIn) institutionalisation in policy decisions — evidence-based programmatic adoption [S2].
Strategic: Supports India's commitment to End TB by 2025 (SDG 3.3 target 2030) [S3][S4].

Sep 2024: MoHFW approved BPaLM regimen rollout under NTEP [S2].
Dec 2024: 100-Day TB Mukt Bharat Abhiyaan intensified campaign launched [S3].
24 Mar 2025: World TB Day 2025 — theme reiterated India's accelerated elimination push [S5].
12 Feb 2026: ICMR-NIRT cost-effectiveness study published in IJMR [S1].

BPaLM = Bedaquiline + Pretomanid + Linezolid + Moxifloxacin; BPaL lacks moxifloxacin [S1][S2].
Treatment duration of BPaL/BPaLM = 6 months (vs 18-20 month longer regimen) [S1].
Study conducted by ICMR-NIRT, headquartered in Chennai [S1].
Published in the Indian Journal of Medical Research [S1].
Incremental cost = ₹37 per additional QALY (BPaLM vs standard) [S2].
NTEP target: End TB by 2025 (5 years ahead of SDG) [S3].
Pradhan Mantri TB Mukt Bharat Abhiyaan launched on 9 Sep 2022 by President Droupadi Murmu [S4].
Bedaquiline = diarylquinoline class; Pretomanid = nitroimidazole class anti-TB drug [S2].
RNTCP renamed NTEP in 2020 [S3].
MDR-TB = resistant to at least isoniazid + rifampicin; RR-TB = rifampicin-resistant.
India's estimated DR-TB patients: ~75,000 [S2].
Health Technology Assessment done by Department of Health Research [S2].

GS-II: Issues relating to Health — Government policies and interventions for development in social sectors.
GS-III: Science & Technology — developments and applications; indigenisation of technology.
Possible question stems: 1. "Discuss how Health Technology Assessment is reshaping India's response to drug-resistant tuberculosis. Examine with reference to BPaL/BPaLM regimens." 2. "India aims to eliminate TB by 2025. Critically evaluate the role of shorter all-oral regimens and the National TB Elimination Programme in achieving this goal." 3. "Antimicrobial resistance threatens global public health. In this context, evaluate India's pharmacological and programmatic interventions against MDR-TB."

NTEP & Nikshay Poshan Yojana — nutritional support DBT for TB patients.
Pradhan Mantri TB Mukt Bharat Abhiyaan & Ni-kshay Mitra — community engagement model.
Antimicrobial Resistance (AMR) National Action Plan — links to drug-resistant pathogens.
WHO End TB Strategy / SDG 3.3 — global benchmark.
ICMR institutes (NIRT Chennai, NIV Pune, etc.) — frequently asked in Prelims.
Health Technology Assessment in India (HTAIn) — DHR initiative.
Universal Immunisation Programme & BCG vaccine — TB prevention angle.
Ayushman Bharat (PM-JAY) — financing of catastrophic health costs.

BPaL ≠ BPaLM — the 'M' is Moxifloxacin, not Mycobacterium or Metronidazole.
ICMR-NIRT is in Chennai, not Delhi or Agra (NJIL&OMD is in Agra).
NTEP is under MoHFW, but the study is by ICMR/DHR — separate departments.
India's TB elimination target is 2025, not 2030 (which is the SDG global target).
Bedaquiline approval and BPaLM rollout are separate milestones; BPaLM approval in India = 2024, not 2026.
RNTCP was renamed NTEP in 2020, not 2018.

[S1] Shorter All-Oral Regimens for Drug-Resistant TB are Cost-Effective in India: ICMR Study — https://www.pib.gov.in/PressReleasePage.aspx?PRID=2226770 — (tier 1)
[S2] Union Health Ministry approves introduction of new shorter and more efficacious treatment regimen for drug-resistant TB in India — https://www.pib.gov.in/PressReleasePage.aspx?PRID=2052515 — (tier 1)
[S3] India's 100-Day TB Elimination Campaign — https://www.pib.gov.in/PressReleaseIframePage.aspx?PRID=2081662 — (tier 1)
[S4] President launches Pradhan Mantri TB Mukt Bharat Abhiyaan — https://www.pib.gov.in/PressReleasePage.aspx?PRID=1858006 — (tier 1)
[S5] World Tuberculosis (TB) Day – 2025 — https://www.pib.gov.in/PressReleasePage.aspx?PRID=2114549 — (tier 1)