The potential impact, cost and cost-effectiveness of tuberculosis interventions - a modelling exercise

Area of Science:

• Global Health
• Epidemiology
• Health Economics

Background:

• Tuberculosis (TB) interventions vary widely in impact and cost-effectiveness.
• Comparisons are often lacking, especially across diverse epidemiological settings.
• Understanding population-level effects and economic viability is critical for TB control.

Purpose of the Study:

• To compare the population impact and cost-effectiveness of various TB interventions.
• To evaluate interventions in Brazil, India, and South Africa, countries with different TB burdens.
• To inform policy and funding for effective TB control strategies.

Main Methods:

• A deterministic TB model was calibrated to epidemiological data from Brazil, India, and South Africa.
• Seven interventions (prevention, screening, treatment, prison screening, nutritional supplementation) were modeled.
• Standardized scale-up, coverage (80%), and efficacy data were used to estimate impact and ICERs by 2050.

Main Results:

• Vaccination, community-wide screening, and prison screening showed the greatest impact (>10% of incident TB episodes averted).
• Shortened drug-resistant TB treatment was cost-saving; prison screening in Brazil and nutritional supplementation in India had low ICERs.
• Community-wide screening and TB vaccine campaigns were more cost-effective than TB preventive treatment within countries.

Conclusions:

• High-impact TB interventions can be cost-effective.
• Effective strategies require targeting populations beyond traditional healthcare settings.
• A shift in funding, policy, and product development is necessary to realize TB control potential.