The Lancet Global Health (Nov 2016)
Cost-effectiveness and resource implications of aggressive action on tuberculosis in China, India, and South Africa: a combined analysis of nine models
- Prof. Nicolas A Menzies, PhD,
- Gabriela B Gomez, PhD,
- Fiammetta Bozzani, MSc,
- Susmita Chatterjee, PhD,
- Nicola Foster, MPH,
- Ines Garcia Baena, MSc,
- Yoko V Laurence, MSc,
- Prof. Sun Qiang, PhD,
- Andrew Siroka, PhD,
- Sedona Sweeney, MSc,
- Stéphane Verguet, PhD,
- Nimalan Arinaminpathy, DPhil,
- Andrew S Azman, PhD,
- Eran Bendavid, MD,
- Stewart T Chang, PhD,
- Prof. Ted Cohen, DPH,
- Justin T Denholm, PhD,
- David W Dowdy, MD,
- Philip A Eckhoff, PhD,
- Jeremy D Goldhaber-Fiebert, PhD,
- Andreas Handel, PhD,
- Grace H Huynh, PhD,
- Marek Lalli, MSc,
- Hsien-Ho Lin, ScD,
- Sandip Mandal, PhD,
- Emma S McBryde, PhD,
- Surabhi Pandey, PhD,
- Prof. Joshua A Salomon, PhD,
- Sze-chuan Suen, MS,
- Tom Sumner, PhD,
- James M Trauer, MBBS,
- Bradley G Wagner, PhD,
- Prof. Christopher C Whalen, MD,
- Chieh-Yin Wu, MS,
- Delia Boccia, PhD,
- Vineet K Chadha, MD,
- Salome Charalambous, PhD,
- Daniel P Chin, MD,
- Prof. Gavin Churchyard, PhD,
- Colleen Daniels, MA,
- Puneet Dewan, MD,
- Lucica Ditiu, MD,
- Jeffrey W Eaton, PhD,
- Prof. Alison D Grant, PhD,
- Piotr Hippner, MSc,
- Mehran Hosseini, MD,
- David Mametja, MPH,
- Carel Pretorius, PhD,
- Yogan Pillay, PhD,
- Kiran Rade, MD,
- Suvanand Sahu, MD,
- Lixia Wang, MS,
- Rein M G J Houben, PhD,
- Michael E Kimerling, MD,
- Richard G White, PhD,
- Anna Vassall, PhD
Affiliations
- Prof. Nicolas A Menzies, PhD
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
- Gabriela B Gomez, PhD
- Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
- Fiammetta Bozzani, MSc
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Susmita Chatterjee, PhD
- Public Health Foundation of India, Delhi NCR, India
- Nicola Foster, MPH
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Ines Garcia Baena, MSc
- Monitoring and Evaluation Unit, Geneva, Switzerland
- Yoko V Laurence, MSc
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Prof. Sun Qiang, PhD
- School of Health Care Management and Key Laboratory of Health Economics and Policy Research of Ministry of Health, Shandong University, Jinan, China
- Andrew Siroka, PhD
- Global TB Programme, Geneva, Switzerland
- Sedona Sweeney, MSc
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Stéphane Verguet, PhD
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
- Nimalan Arinaminpathy, DPhil
- Public Health Foundation of India, Delhi NCR, India
- Andrew S Azman, PhD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Eran Bendavid, MD
- Department of Medicine, Stanford University, Stanford, CA, USA
- Stewart T Chang, PhD
- Institute for Disease Modeling, Seattle, WA, USA
- Prof. Ted Cohen, DPH
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- Justin T Denholm, PhD
- Victorian Tuberculosis Program at the Peter Doherty Institute, Melbourne, VIC, Australia
- David W Dowdy, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Philip A Eckhoff, PhD
- Institute for Disease Modeling, Seattle, WA, USA
- Jeremy D Goldhaber-Fiebert, PhD
- Stanford Health Policy, Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
- Andreas Handel, PhD
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
- Grace H Huynh, PhD
- Institute for Disease Modeling, Seattle, WA, USA
- Marek Lalli, MSc
- TB Modelling Group, TB Centre, London School of Hygiene & Tropical Medicine, London, UK
- Hsien-Ho Lin, ScD
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
- Sandip Mandal, PhD
- Public Health Foundation of India, Delhi NCR, India
- Emma S McBryde, PhD
- Victorian Tuberculosis Program at the Peter Doherty Institute, Melbourne, VIC, Australia
- Surabhi Pandey, PhD
- Public Health Foundation of India, Delhi NCR, India
- Prof. Joshua A Salomon, PhD
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
- Sze-chuan Suen, MS
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
- Tom Sumner, PhD
- TB Modelling Group, TB Centre, London School of Hygiene & Tropical Medicine, London, UK
- James M Trauer, MBBS
- Victorian Tuberculosis Program at the Peter Doherty Institute, Melbourne, VIC, Australia
- Bradley G Wagner, PhD
- Institute for Disease Modeling, Seattle, WA, USA
- Prof. Christopher C Whalen, MD
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
- Chieh-Yin Wu, MS
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
- Delia Boccia, PhD
- Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK
- Vineet K Chadha, MD
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India
- Salome Charalambous, PhD
- Aurum Institute, Johannesburg, South Africa
- Daniel P Chin, MD
- Bill & Melinda Gates Foundation, Seattle, WA, USA
- Prof. Gavin Churchyard, PhD
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- Colleen Daniels, MA
- Stop TB Partnership, Geneva, Switzerland
- Puneet Dewan, MD
- Bill & Melinda Gates Foundation, New Delhi, India
- Lucica Ditiu, MD
- Stop TB Partnership, Geneva, Switzerland
- Jeffrey W Eaton, PhD
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- Prof. Alison D Grant, PhD
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- Piotr Hippner, MSc
- Aurum Institute, Johannesburg, South Africa
- Mehran Hosseini, MD
- Strategic Information Department, The Global Fund, Geneva, Switzerland
- David Mametja, MPH
- National Department of Health, Pretoria, South Africa
- Carel Pretorius, PhD
- Avenir Health, Glastonbury, CT, USA
- Yogan Pillay, PhD
- National Department of Health, Pretoria, South Africa
- Kiran Rade, MD
- World Health Organization Country Office for India, New Delhi, India
- Suvanand Sahu, MD
- Stop TB Partnership, Geneva, Switzerland
- Lixia Wang, MS
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- Rein M G J Houben, PhD
- TB Modelling Group, TB Centre, London School of Hygiene & Tropical Medicine, London, UK
- Michael E Kimerling, MD
- KNCV Tuberculosis Foundation, The Hague, Netherlands
- Richard G White, PhD
- TB Modelling Group, TB Centre, London School of Hygiene & Tropical Medicine, London, UK
- Anna Vassall, PhD
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- DOI
- https://doi.org/10.1016/S2214-109X(16)30265-0
- Journal volume & issue
-
Vol. 4,
no. 11
pp. e816 – e826
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.
