Cost-effectiveness and resource implications of aggressive action on TB in China, India, and South Africa: a combined analysis of nine models
Summary
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.
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Source:
The Lancet Global Health
