Cost-effectiveness and resource implications of aggressive action on TB

Menzies, N.A., Gomez, G.B., Bozzani, F., Chatterjee, S., Foster, N., Baena, I.G., Laurence, Y.V., Qiang, S., Siroka, A., Sweeney, S. and Verguet, S., 2016. Cost-effectiveness and resource implications of aggressive action on tuberculosis in China, India, and South Africa: a combined analysis of nine models. The Lancet global health, 4(11), pp.e816-e826.

Health Outcomes:

• Substantial health gains were observed in India, China, and South Africa following expanded access to tuberculosis care.

Cost-Effectiveness:

• Most intervention approaches were highly cost-effective compared to current practices and conventional cost-effectiveness thresholds.
• Efforts to improve access to care proved to be notably beneficial and cost-effective in each setting analyzed.

Policy Considerations:

• Significant differences in the effectiveness and efficiency of various approaches necessitate careful planning in service expansion.
• Implementing expanded services effectively would require substantial new funding.

Cost Implications:

• Incremental costs for tuberculosis services varied by scenario and country, sometimes more than doubling the existing funding needs.

Economic and Health Benefits:

• Expansion of tuberculosis services generally reduced patient-incurred costs.
• In India and China, most interventions resulted in net cost savings from a societal perspective.

 

Dye, C., Garnett, G.P., Sleeman, K. and Williams, B.G., 1998. Prospects for worldwide tuberculosis control under the WHO DOTS strategy. The Lancet, 352(9144), pp.1886-1891.

The fall in tuberculosis incidence under DOTS is greater in younger populations than in older ones.

Non-curative treatment can prevent death without eliminating infectiousness. See also: https://tbreadingnotes.blogspot.com/2024/10/quantifying-global-number-of.html

In countries where tuberculosis incidence is stable and HIV-1 is absent:

• A control program reaching WHO targets (70% case detection, 85% cure) would reduce the incidence rate by 11% per year (range 8–12%).
• It would reduce the death rate by 12% per year (range 9–13%).

If tuberculosis has been in decline for several years, the same case detection and cure rates would have a smaller effect on incidence. See also: https://tbreadingnotes.blogspot.com/2024/10/type-2-diabetes-mellitus-and-recurrent.html

DOTS saves a greater proportion of deaths than cases, with a larger difference in the presence of HIV-1.

HIV-1 epidemics increase tuberculosis incidence but do not significantly reduce the preventable proportion of cases and deaths. See also: https://tbreadingnotes.blogspot.com/2024/08/immunologic-metabolic-and-genetic.html

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Sorokina, M., Ukubayev, T. and Koichubekov, B., 2023. Tuberculosis incidence and its socioeconomic determinants: developing a parsimonious model. Annali di Igiene, Medicina Preventiva e di Comunita, 35(4): 468-479.

· There is a strong relationship between economic indicators and health expenditure.

· In bivariate analysis, per-capita GDP, per-capita income, proportion of the poor, unemployment rate, CHE per capita, number of GPs, and number of TB hospital beds were significant predictors of TB incidence rate.

· Two key components, economic development and healthcare capacity, were identified.

· Both economic development and healthcare capacity have a significant negative effect on TB incidence.

· The findings are based on population-level data and indicate that stronger economies and better healthcare systems reduce TB incidence, though the results cannot be applied to individuals directly.