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 [1].
• 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.

2. Why in the News

• 12 Feb 2026 PIB release on ICMR-NIRT cost-effectiveness study supporting programmatic scale-up of BPaL/BPaLM under NTEP [1].
• Follows 2024 MoHFW approval of BPaLM as the new MDR-TB regimen [2].

3. Background & Evolution

• 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 [3].
• Pradhan Mantri TB Mukt Bharat Abhiyaan launched by President Droupadi Murmu on 9 Sep 2022 [4].
• 2024: MoHFW approved BPaLM (Bedaquiline + Pretomanid + Linezolid + Moxifloxacin) — endorsed after Health Technology Assessment by Department of Health Research [2].
• 100-Day TB Elimination Campaign launched in Dec 2024 [3].

4. Core Static Facts

• Conducting body: ICMR–National Institute for Research in Tuberculosis (ICMR-NIRT), Chennai [1].
• Parent ministry: Ministry of Health & Family Welfare; research arm — Department of Health Research / ICMR [2].
• Programme: National TB Elimination Programme (NTEP) [1][2].
• 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 [1].

• Key cost-effectiveness number: BPaLM = additional INR 37 per patient per additional QALY gained; BPaL = cost-saving and more effective [2].

• MDR/RR-TB burden cited: ~75,000 drug-resistant TB patients in India to benefit [2].
• Publication: Indian Journal of Medical Research (IJMR) [1].

5. Multi-Dimensional Analysis

• 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 [2]. 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 [2].
• 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 [2].
• Administrative/Governance: Demonstrates Health Technology Assessment India (HTAIn) institutionalisation in policy decisions — evidence-based programmatic adoption [2].
• Strategic: Supports India's commitment to End TB by 2025 (SDG 3.3 target 2030) [3][4].

6. Recent Developments (last 12-18 months)

• Sep 2024: MoHFW approved BPaLM regimen rollout under NTEP [2].
• Dec 2024: 100-Day TB Mukt Bharat Abhiyaan intensified campaign launched [3].
• 24 Mar 2025: World TB Day 2025 — theme reiterated India's accelerated elimination push [5].
• 12 Feb 2026: ICMR-NIRT cost-effectiveness study published in IJMR [1].

7. Prelims Hooks

• BPaLM = Bedaquiline + Pretomanid + Linezolid + Moxifloxacin; BPaL lacks moxifloxacin [1][2].
• Treatment duration of BPaL/BPaLM = 6 months (vs 18-20 month longer regimen) [1].
• Study conducted by ICMR-NIRT, headquartered in Chennai [1].
• Published in the Indian Journal of Medical Research [1].
• Incremental cost = ₹37 per additional QALY (BPaLM vs standard) [2].
• NTEP target: End TB by 2025 (5 years ahead of SDG) [3].
• Pradhan Mantri TB Mukt Bharat Abhiyaan launched on 9 Sep 2022 by President Droupadi Murmu [4].
• Bedaquiline = diarylquinoline class; Pretomanid = nitroimidazole class anti-TB drug [2].
• RNTCP renamed NTEP in 2020 [3].
• MDR-TB = resistant to at least isoniazid + rifampicin; RR-TB = rifampicin-resistant.
• India's estimated DR-TB patients: ~75,000 [2].
• Health Technology Assessment done by Department of Health Research [2].

8. Mains Relevance

• 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."

9. Related Topics to Study Next

• 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.

10. Common Errors / Trap Areas

• 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.