World TB Day: A Critical Juncture for India's Fight Against TB

March 24th, 2025 - World TB Day serves as a crucial platform to:

Enhance public awareness about the devastating health, social and economic consequences of tuberculosis (TB)
Galvanize global efforts towards eradicating the TB epidemic

India bears a disproportionately high burden of global TB cases:

27% of worldwide cases in 2022

Source: WHO Global Tuberculosis Report

Globally, an estimated 10.8 million individuals fell ill with TB in 2023.

The economic consequences of TB are substantial for individuals, families, and the nation, primarily stemming from:

Reduced productivity
Increased healthcare expenditures

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TB: More Than a Health Crisis – A Significant Economic Drain

Key Economic Impacts

Loss of Productivity

TB affects individuals during their most productive years (15-54):

28,627.7 person-years lost (unskilled labor)
4,496.3 person-years lost (skilled labor)

Projected losses 2021-2040 (Keogh-Brown et al., 2024)

Out-of-Pocket Expenditure

Average pre-diagnosis cost: US$114.2

Study in Bengaluru (Sinha et al., 2020)

Catastrophic Costs

45%

of TB patients experience costs exceeding 20% of annual household income

Jeyashree et al., 2024

Median total cost of TB care: US$386.1 (US$78.4 direct, US$279.8 indirect)

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Prioritizing Health: Comparing Government Investments

TB Elimination Funding

India's funding gap for TB elimination:

Period	Planned (Rs billion)	Allocated (Rs billion)	Shortfall
2017-2020	123.27	83.13	40.14 (33%)

IndiaSpend, 2025

2024 TB Elimination Budget: ₹31 billion

Compared to AIDS/STD Control Budget: ₹30.49 billion

The Economic Rationale for NTEP

Given the significant economic burden of TB, increased investment is crucial because:

TB interventions are highly cost-effective
Potential for strong return on investment
Long-term economic benefits of a TB-free India

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NTEP: An Economically Sound Investment

Cost-Effectiveness of TB Interventions

Intervention	Unit Cost (US$)
Sputum smear microscopy	2.45
Xpert MTB/RIF	17.36

Chatterjee et al., 2021

Scale-up of TB control (1997-2006) generated:

US$115 return per dollar spent

Goodchild et al., 2011

Return on Investment

1

Reduced TB incidence and prevalence leading to decreased long-term economic burden

2

Improved workforce productivity and economic growth

3

Preventing drug resistance – a cost-saving measure

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Beyond Treatment: NTEP's Multi-Faceted Programs

Nikshay Poshan Yojana (NPY)

Objective: Provide ₹500/month nutritional support to TB patients

Impact (2025): ₹3,202 crores disbursed to 1.13 crore beneficiaries

Challenge: Delays in receiving installments

Active Case Finding (ACF)

Objective: Increase TB case detection through community screening

Impact (2021): 22.3 million individuals screened, 34 States/UTs covered

2023-24: 25.5-26.07 lakh cases notified

TB-Free India Campaign

Objective: Improve case detection and reduce diagnostic delays

Initiative: 100-Day TB Elimination Campaign

Impact: Declining TB incidence and mortality rates

Public-Private Partnerships

Objective: Enhance service delivery and resources

Role: Key to India's TB elimination goals

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Why Invest in TB Elimination? The Economic Case

1

Reduced Economic Burden: TB elimination reduces lost productivity, out-of-pocket expenditures, and overall strain on the economy

2

Cost-Effective Interventions: NTEP provides interventions with measurable unit costs and proven effectiveness

3

Return on Investment: US$115 return per dollar spent on TB control scale-up

4

Social Equity: TB disproportionately affects vulnerable populations; targeted interventions address health inequities

5

Global Health Security: Controlling TB in India prevents spread of drug-resistant strains worldwide

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The Economic Imperative: Medical Students as Agents of Change

Conclusion

The economic rationale for investing in TB elimination in India is compelling and multifaceted:

Substantial economic burden from lost productivity and healthcare costs
Cost-effective interventions with strong ROI available
Multi-sectoral benefits including poverty reduction and economic growth

Working towards a TB-free India is not only a public health imperative but also an economic necessity for the nation's prosperity.

Call to Action

Postgraduate medical students can play vital roles by:

Clinical Practice

• Ensure early and accurate diagnosis
• Provide effective treatment to all patients

Patient Education

• Emphasize treatment adherence
• Provide counseling and support

Advocacy

• Advocate for increased TB program funding
• Support policy initiatives for TB elimination

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References

World Health Organization. Global Tuberculosis Report (Latest Edition)
National TB Elimination Programme (NTEP), Ministry of Health and Family Welfare, India. Program Guidelines and Reports
Jeyashree, K et al. Cost of TB care and equity in distribution of catastrophic TB care costs across income quintiles in India. Global Health Research and Policy 2024
Nagaraja, SB et al. Active Case Finding for Tuberculosis in India. Tropical Medicine and Infectious Disease 2021
MOHFW. India Launches 100-Day TB Elimination Campaign. Press Information Bureau 2024
Operational Manual for Partnerships under National TB Elimination Programme. Central TB Division 2023
Silke, F et al. Cost-effectiveness of interventions for HIV/AIDS, malaria, syphilis, and tuberculosis in 128 countries. BMC Health Serv Res 2024
IndiaSpend. 2025 TB Elimination Goal Marred By Low Govt Spending. 2025
Sinha, P et al. How much do Indians pay for tuberculosis treatment? IJTLD 2020
Chatterjee, S et al. Costs of TB services in India. IJTLD 2021
Keogh-Brown, MR et al. Estimating the health and macroeconomic burdens of tuberculosis in India, 2021–2040. PLoS Med 2024
Goodchild, M et al. A cost-benefit analysis of scaling up tuberculosis control in India. Health Econ. 2011

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