Optimizing TB policies using the global TB portfolio model: an economic analysis

Area of Science:

• Global health economics
• Epidemiology
• Health systems research

Background:

• Tuberculosis (TB) is a major global health challenge, particularly in low- and middle-income countries.
• Effective resource allocation is critical for achieving World Health Organization (WHO) End TB targets.
• Existing costing tools lack the capability for comprehensive global TB analyses.

Purpose of the Study:

• To develop a novel, open-source TB costing model for detailed global analyses.
• To simulate TB care cascades across diverse population groups and care pathways.
• To inform strategic investment and resource allocation for TB control.

Main Methods:

• Developed an open-source model simulating TB screening, diagnosis, treatment, and prevention cascades.
• Incorporated 20 distinct population groups based on WHO guidelines (patient- and provider-initiated pathways).
• Modeled costs for variations in pulmonary status, age, HIV/ART status, drug sensitivity, and large-scale vaccine implementation.

Main Results:

• The model estimated costs for implementing the TB Global Plan 2023-2030, including new tools and standards of care.
• An optimization routine identified maximal TB impact strategies under funding constraints in 29 high-burden countries.
• Results informed the Global Fund's Investment Case for its 8th replenishment (2027-2029).

Conclusions:

• The new TB costing model provides enhanced representation of TB care complexity and diversity.
• Offers improved transparency, flexibility, and policy relevance for global TB strategy analysis.
• Demonstrates value in informing investment cases and prioritizing interventions for maximum impact under resource constraints.