Economic Burden and Transmission Dynamics

Economic Burden and Cost-Effectiveness of TB Treatments

• The BPaL regimen for drug-resistant TB in the Philippines significantly reduces both direct and indirect patient costs compared to existing regimens.
• Economic evaluations (ACER and ICER) showed BPaL is cost-effective under GDP-based thresholds.
• BPaL also improves treatment success rates, highlighting economic and health benefits.
• Lower catastrophic health expenditures and reduced healthcare visits make BPaL advantageous for real-world implementation.
• The study recommends national TB programs transition toward routine BPaL adoption.

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Diabetes Costs and Integration with TB Care

• DM outpatient visits in the Philippines accounted for 3–13% of all visits; monthly drug costs per patient averaged USD 7.67.
• Costs varied by diagnostic test: RPG USD 1.67, FBS USD 2.99, OGTT USD 23.72.
• Staff time was the largest cost driver for non-lab services, while consumables dominated lab costs.
• The cost per DM case detected among TB patients was lowest using RPG plus FBS algorithms (USD 17.43).
• Findings highlight the need for planning integrated TB-DM services and understanding economic burdens.

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Transmission Dynamics and Risk Factors for TB

• In Lima, Peru, genomic sequencing of 2,500 TB cases identified over 1,400 direct transmission pairs.
• Higher transmission was linked to younger age, male gender, smoking, drinking, and incarceration.
• Cavitary disease and previous TB increased transmissibility.
• The study demonstrates the power of genomic tools in identifying high-risk groups for targeted interventions.
• Former prisoners and substance users should be prioritized in TB control efforts.

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Impact of Smoking Cessation on Household TB Transmission

• Recent smoking cessation among TB patients significantly reduced TB infection risk in child contacts.
• Children of recent quitters had infection rates similar to those of never-smokers.
• Risk ratios for infection were about half compared to contacts of active smokers.
• Results were consistent after adjusting for disease severity and restricting to younger children.
• The study underscores smoking cessation as an effective, rapid intervention to lower TB spread in households.

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TB and Diabetes Syndemic: Challenges and Opportunities

• Diabetes delays TB diagnosis, worsens disease severity (e.g., cavitary lesions), and increases mortality and relapse rates.
• Hyperglycemia—whether pre-existing or treatment-induced—predicts worse TB outcomes.
• M. tuberculosis infection can disrupt metabolism, contributing to insulin resistance.
• Certain diabetes medications (e.g., metformin) may improve TB immunopathology, while TB treatments can worsen glycemic control.
• Integrated care models with enhanced screening, tailored regimens, and glycemic monitoring are critical to improving outcomes in this syndemic.

See also: Lin TB Lab

References:

1. Yamanaka, T., Castro, M.C., Ferrer, J.P., Solon, J.A., Cox, S.E., Laurence, Y.V. and Vassall, A., 2024. Health system costs of providing outpatient care for diabetes in people with TB in the Philippines. IJTLD open, 1(3), pp.124-129.
2. Evans, D., Hirasen, K., Casalme, D.J., Gler, M.T., Gupta, A. and Juneja, S., 2024. Cost and cost-effectiveness of BPaL regimen used in drug-resistant TB treatment in the Philippines. IJTLD open, 1(6), pp.242-249.
3. Chu, A.L., Lecca, L.W., Calderón, R.I., Contreras, C.C., Yataco, R.M., Zhang, Z., Becerra, M.C., Murray, M.B. and Huang, C.C., 2021. Smoking cessation in tuberculosis patients and the risk of tuberculosis infection in child household contacts. Clinical Infectious Diseases, 73(8), pp.1500-1506.
4. Trevisi, L., Brooks, M.B., Becerra, M.C., Calderón, R.I., Contreras, C.C., Galea, J.T., Jimenez, J., Lecca, L., Yataco, R.M., Tovar, X. and Zhang, Z., 2024. Who transmits tuberculosis to whom: a cross-sectional analysis of a cohort study in Lima, Peru. American Journal of Respiratory and Critical Care Medicine, 210(2), pp.222-233.
5. Magodoro, I., Kotze, L., Stek, C.J., West, A., Le Roux, A., Sobratee, N., Taliep, A., Hamada, Y., Dave, J.A., Rangaka, M.X. and Parihar, S.P., 2025. Clinical, metabolic and immune interaction between tuberculosis and diabetes mellitus: implications and opportunities for therapies. Expert Opinion on Pharmacotherapy.
6. Pratiwi, R.D., Alisjahbana, B., Subronto, Y.W., Priyanta, S. and Suharna, S., 2025. Implementation of an information system for tuberculosis in healthcare facilities in Indonesia: evaluation of its effectiveness and challenges. Archives of Public Health, 83(1), pp.1-18.

Yoseph Samodra

TBC 068