What is NTBC for Metabolic Liver Disease And Its Cost?

Understanding NTBC’s Role in Treating Metabolic Liver Disease and Its Cost Implications

NTBC (Nitisinone) is a life‑saving therapy for Hereditary Tyrosinemia Type 1 (HT‑1). It is a rare metabolic liver disease and affects 1 in a lakh population in India. As of 2025, domestically manufactured NTBC (Nitisinone) capsules are available in India at approximately ₹2.5 lakh per year, while imported versions previously cost up to ₹2.2 crore annually before indigenous production began.

What Causes Hereditary Tyrosinaemia Type 1 Disease?

Hereditary Tyrosinemia Type 1 is an autosomal condition caused by a deficiency of fumarylacetoacetate hydrolase (FAH). It is an enzyme essential for breaking down the amino acid tyrosine. Without it, toxic metabolites like fumarylacetoacetate and succinylacetone accumulate, and this leads to progressive liver and kidney damage, rickets, and bleeding tendencies.

Role of NTBC (Nitisinone) in HT-1 Treatment

NTBC plays a crucial role in managing HT-1 treatment. Here is how it helps:

1. Mechanism of Action

NTBC works by preventing the formation of harmful metabolites further down the tyrosine degradation pathway. This stops succinylacetone accumulation and protects our liver and kidneys.

2. Dosage Guidelines

Clinical guidelines recommend a starting dose of approximately 1 mg/kg/day, divided into two doses for infants. Some protocols allow once‑daily dosing in adults. Doctors adjust the dose to suppress succinylacetone and maintain therapeutic plasma levels of NTBC.

3. Impact on Prognosis

Before NTBC, most untreated children with HT‑1 died before age 2 to 3 from liver failure or hepatocellular carcinoma. With early NTBC therapy and dietary management, survival has improved drastically up to 90%.

What is the Cost of NTBC Treatment in India?

The cost of NTBC (Nitisinone) treatment in India for HT-1 can vary, but it is generally considered expensive and not always readily available. While the annual cost of imported Nitisinone capsules is around Rs. 2.2 crore, the domestically manufactured version is available for Rs. 2.5 lakh.

Factors like dosage, treatment duration, and whether patients obtain it through government schemes or private hospitals influence the overall cost. Always consult your doctor to get an accurate cost estimate.

Challenges with Metabolic Liver Disease Treatment in India

Here are several challenges patients face with metabolic liver disease treatment in India:

1. Access Challenges

NTBC, a life-saving medication for HT-1, is often not readily available in India, and even when available, it is prohibitively expensive for many patients.

2. Long‑Term Monitoring

Patients on NTBC need periodic liver and kidney function tests and regular ophthalmology reviews to monitor potential complications.

3. Lack of Newborn Screening

HT-1 is not typically included in newborn screening panels in India, which can delay diagnosis and treatment initiation, especially in the absence of a high index of clinical suspicion.

NTBC has revolutionised HT‑1 treatment. In India, the cost has been reduced from Rs. 2.2 crore to Rs. 2.5 lakh makes therapy accessible to many families. When combined with timely diagnosis, strict dietary management and regular monitoring, NTBC enables a fatal condition to become a manageable, treatable one.