Cost-effectiveness and resource implications of aggressive action on tuberculosis in China, India, and South Africa: a combined analysis of nine models.


Menzies, NA; Gomez, GB; Bozzani, F; Chatterjee, S; Foster, N; Baena, IG; Laurence, YV; Qiang, S; Siroka, A; Sweeney, S; Verguet, S; Arinaminpathy, N; Azman, AS; Bendavid, E; Chang, ST; Cohen, T; Denholm, JT; Dowdy, DW; Eckhoff, PA; Goldhaber-Fiebert, JD; Handel, A; Huynh, GH; Lalli, M; Lin, HH; Mandal, S; McBryde, ES; Pandey, S; Salomon, JA; Suen, SC; Sumner, T; Trauer, JM; Wagner, BG; Whalen, CC; Wu, CY; Boccia, D; Chadha, VK; Charalambous, S; Chin, DP; Churchyard, G; Daniels, C; Dewan, P; Ditiu, L; Eaton, JW; Grant, AD; Hippner, P; Hosseini, M; Mametja, D; Pretorius, C; Pillay, Y; Rade, K; Sahu, S; Wang, L; Houben, RM; Kimerling, ME; White, RG; Vassall, A; (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. ISSN 2214-109X DOI: https://doi.org/10.1016/S2214-109X(16)30265-0

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Abstract

The post-2015 End TB Strategy sets global targets of reducing tuberculosis incidence by 50% and mortality by 75% by 2025. We aimed to assess resource requirements and cost-effectiveness of strategies to achieve these targets in China, India, and South Africa. We examined intervention scenarios developed in consultation with country stakeholders, which scaled up existing interventions to high but feasible coverage by 2025. Nine independent modelling groups collaborated to estimate policy outcomes, and we estimated the cost of each scenario by synthesising service use estimates, empirical cost data, and expert opinion on implementation strategies. We estimated health effects (ie, disability-adjusted life-years averted) and resource implications for 2016-35, including patient-incurred costs. To assess resource requirements and cost-effectiveness, we compared scenarios with a base case representing continued current practice. Incremental tuberculosis service costs differed by scenario and country, and in some cases they more than doubled existing funding needs. In general, expansion of tuberculosis services substantially reduced patient-incurred costs and, in India and China, produced net cost savings for most interventions under a societal perspective. In all three countries, expansion of access to care produced substantial health gains. Compared with current practice and conventional cost-effectiveness thresholds, most intervention approaches seemed highly cost-effective. Expansion of tuberculosis services seems cost-effective for high-burden countries and could generate substantial health and economic benefits for patients, although substantial new funding would be required. Further work to determine the optimal intervention mix for each country is necessary. Bill & Melinda Gates Foundation.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Faculty of Public Health and Policy > Dept of Global Health and Development
Research Centre: TB Centre
Social and Mathematical Epidemiology (SaME)
SaME Modelling & Economics
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PubMed ID: 27720689
Web of Science ID: 386811200023
URI: http://researchonline.lshtm.ac.uk/id/eprint/2965134

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