Format

Send to

Choose Destination
See comment in PubMed Commons below
Lancet Glob Health. 2016 Nov;4(11):e816-e826. doi: 10.1016/S2214-109X(16)30265-0. Epub 2016 Oct 6.

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

Author information

1
Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Center for Health Decision Science, Harvard T H Chan School of Public Health, Boston, MA, USA. Electronic address: nmenzies@hsph.harvard.edu.
2
Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands; Department of Global Health, Academic Medical Center, University of Amsterdam, Netherlands; Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
3
Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
4
Public Health Foundation of India, Delhi NCR, India.
5
Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
6
Monitoring and Evaluation Unit, Geneva, Switzerland.
7
School of Health Care Management and Key Laboratory of Health Economics and Policy Research of Ministry of Health, Shandong University, Jinan, China.
8
Global TB Programme, Geneva, Switzerland.
9
Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
10
Public Health Foundation of India, Delhi NCR, India; Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
11
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
12
Department of Medicine, Stanford University, Stanford, CA, USA.
13
Institute for Disease Modeling, Seattle, WA, USA.
14
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
15
Victorian Tuberculosis Program at the Peter Doherty Institute, Melbourne, VIC, Australia; Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia.
16
Stanford Health Policy, Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA.
17
Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA.
18
Institute for Disease Modeling, Seattle, WA, USA; Synthetic Neurobiology Group, Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA.
19
TB Modelling Group, TB Centre, London School of Hygiene & Tropical Medicine, London, UK; Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK.
20
Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
21
Victorian Tuberculosis Program at the Peter Doherty Institute, Melbourne, VIC, Australia; Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia; Burnet Institute, Melbourne, VIC, Australia.
22
Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Center for Health Decision Science, Harvard T H Chan School of Public Health, Boston, MA, USA.
23
Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.
24
Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK.
25
Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India.
26
Aurum Institute, Johannesburg, South Africa.
27
Bill & Melinda Gates Foundation, Seattle, WA, USA.
28
Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; Aurum Institute, Johannesburg, South Africa; School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
29
Stop TB Partnership, Geneva, Switzerland.
30
Bill & Melinda Gates Foundation, New Delhi, India.
31
Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
32
Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; School of Public Health, University of Witwatersrand, Johannesburg, South Africa; Africa Centre for Population Health, School of Nursing & Public Health, University of KwaZulu-Natal, Durban, South Africa.
33
Strategic Information Department, The Global Fund, Geneva, Switzerland.
34
National Department of Health, Pretoria, South Africa.
35
Avenir Health, Glastonbury, CT, USA.
36
World Health Organization Country Office for India, New Delhi, India.
37
National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
38
KNCV Tuberculosis Foundation, The Hague, Netherlands.

Abstract

BACKGROUND:

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.

METHODS:

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.

FINDINGS:

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.

INTERPRETATION:

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.

FUNDING:

Bill & Melinda Gates Foundation.

PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science Icon for PubMed Central
    Loading ...
    Support Center