Cost effectiveness analysis of strategies for tuberculosis control in developing countries

Area of Science:

• Public Health
• Epidemiology
• Health Economics

Background:

• Tuberculosis (TB) remains a significant global health challenge, particularly in Africa and South East Asia.
• Millennium Development Goals (MDGs) aimed to reduce TB incidence and prevalence.
• Effective and cost-efficient TB control strategies are essential for resource-limited settings.

Purpose of the Study:

• To evaluate the cost-effectiveness of various tuberculosis control interventions in Africa and South East Asia.
• To inform strategies for achieving TB-related MDGs.

Main Methods:

• Cost-effectiveness analysis utilizing an epidemiological model.
• Data sourced from published literature, costing databases, and expert opinions.
• Analysis focused on WHO-defined epidemiological regions: Afr-E (Sub-Saharan Africa) and Sear-D (South East Asia).

Main Results:

• Treatment of new smear-positive TB cases via DOTS (Directly Observed Treatment, Short-course) was highly cost-effective, costing $6-8 per DALY averted in Afr-E and $7 in Sear-D.
• Adding smear-negative/extra-pulmonary TB treatment and DOTS-Plus for multidrug-resistant TB increased costs but remained cost-effective ($95-$226 per DALY averted).
• Comprehensive interventions demonstrated potential to reduce TB prevalence and mortality by up to 50% in the studied regions.

Conclusions:

• DOTS for new smear-positive TB cases is the primary priority for TB control, even in high HIV prevalence areas.
• Additional interventions for other TB forms and multidrug-resistant TB are also cost-effective.
• Substantial additional investment is required to scale up TB case-finding and interventions to meet global control targets.