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

Nicolas A. Menzies, Gabriela B. Gomez, Fiammetta Bozzani, Susmita Chatterjee, Nicola Foster, Ines Garcia Baena, Yoko V. Laurence, Sun Qiang, Andrew Siroka, Sedona Sweeney, Stéphane Verguet, Nimalan Arinaminpathy, Andrew Azman, Eran Bendavid, Stewart T. Chang, Ted Cohen, Justin T. Denholm, David Wesley Dowdy, Philip A. Eckhoff, Jeremy D. Goldhaber-FiebertAndreas Handel, Grace H. Huynh, Marek Lalli, Hsien Ho Lin, Sandip Mandal, Emma S. McBryde, Surabhi Pandey, Joshua A. Salomon, Sze chuan Suen, Tom Sumner, James M. Trauer, Bradley G. Wagner, Christopher C. Whalen, Chieh Yin Wu, Delia Boccia, Vineet K. Chadha, Salome Charalambous, Daniel P. Chin, Gavin Churchyard, Colleen Daniels, Puneet Dewan, Lucica Ditiu, Jeffrey W. Eaton, Alison D. Grant, Piotr Hippner, Mehran Hosseini, David Mametja, Carel Pretorius, Yogan Pillay, Kiran Rade, Suvanand Sahu, Lixia Wang, Rein M G J Houben, Michael E. Kimerling, Richard G. White, Anna Vassall

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)e816-e826
JournalThe Lancet Global Health
Volume4
Issue number11
DOIs
StatePublished - Nov 1 2016

Fingerprint

South Africa
Cost-Benefit Analysis
India
China
Tuberculosis
Costs and Cost Analysis
Quality-Adjusted Life Years
Cost Savings
Health
Expert Testimony
Insurance Benefits
Referral and Consultation
Economics
Mortality
Incidence

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Cost-effectiveness and resource implications of aggressive action on tuberculosis in China, India, and South Africa : a combined analysis of nine models. / Menzies, Nicolas A.; Gomez, Gabriela B.; Bozzani, Fiammetta; Chatterjee, Susmita; Foster, Nicola; Baena, Ines Garcia; Laurence, Yoko V.; Qiang, Sun; Siroka, Andrew; Sweeney, Sedona; Verguet, Stéphane; Arinaminpathy, Nimalan; Azman, Andrew; Bendavid, Eran; Chang, Stewart T.; Cohen, Ted; Denholm, Justin T.; Dowdy, David Wesley; Eckhoff, Philip A.; Goldhaber-Fiebert, Jeremy D.; Handel, Andreas; Huynh, Grace H.; Lalli, Marek; Lin, Hsien Ho; Mandal, Sandip; McBryde, Emma S.; Pandey, Surabhi; Salomon, Joshua A.; Suen, Sze chuan; Sumner, Tom; Trauer, James M.; Wagner, Bradley G.; Whalen, Christopher C.; Wu, Chieh Yin; Boccia, Delia; Chadha, Vineet K.; Charalambous, Salome; Chin, Daniel P.; Churchyard, Gavin; Daniels, Colleen; Dewan, Puneet; Ditiu, Lucica; Eaton, Jeffrey W.; Grant, Alison D.; Hippner, Piotr; Hosseini, Mehran; Mametja, David; Pretorius, Carel; Pillay, Yogan; Rade, Kiran; Sahu, Suvanand; Wang, Lixia; Houben, Rein M G J; Kimerling, Michael E.; White, Richard G.; Vassall, Anna.

In: The Lancet Global Health, Vol. 4, No. 11, 01.11.2016, p. e816-e826.

Research output: Contribution to journalArticle

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, A, 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, RMGJ, 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, vol. 4, no. 11, pp. e816-e826. https://doi.org/10.1016/S2214-109X(16)30265-0
Menzies, Nicolas A. ; Gomez, Gabriela B. ; Bozzani, Fiammetta ; Chatterjee, Susmita ; Foster, Nicola ; Baena, Ines Garcia ; Laurence, Yoko V. ; Qiang, Sun ; Siroka, Andrew ; Sweeney, Sedona ; Verguet, Stéphane ; Arinaminpathy, Nimalan ; Azman, Andrew ; Bendavid, Eran ; Chang, Stewart T. ; Cohen, Ted ; Denholm, Justin T. ; Dowdy, David Wesley ; Eckhoff, Philip A. ; Goldhaber-Fiebert, Jeremy D. ; Handel, Andreas ; Huynh, Grace H. ; Lalli, Marek ; Lin, Hsien Ho ; Mandal, Sandip ; McBryde, Emma S. ; Pandey, Surabhi ; Salomon, Joshua A. ; Suen, Sze chuan ; Sumner, Tom ; Trauer, James M. ; Wagner, Bradley G. ; Whalen, Christopher C. ; Wu, Chieh Yin ; Boccia, Delia ; Chadha, Vineet K. ; Charalambous, Salome ; Chin, Daniel P. ; Churchyard, Gavin ; Daniels, Colleen ; Dewan, Puneet ; Ditiu, Lucica ; Eaton, Jeffrey W. ; Grant, Alison D. ; Hippner, Piotr ; Hosseini, Mehran ; Mametja, David ; Pretorius, Carel ; Pillay, Yogan ; Rade, Kiran ; Sahu, Suvanand ; Wang, Lixia ; Houben, Rein M G J ; Kimerling, Michael E. ; White, Richard G. ; Vassall, Anna. / Cost-effectiveness and resource implications of aggressive action on tuberculosis in China, India, and South Africa : a combined analysis of nine models. In: The Lancet Global Health. 2016 ; Vol. 4, No. 11. pp. e816-e826.
@article{650aab05006b43f1b978979a1016c389,
title = "Cost-effectiveness and resource implications of aggressive action on tuberculosis in China, India, and South Africa: a combined analysis of nine models",
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.",
author = "Menzies, {Nicolas A.} and Gomez, {Gabriela B.} and Fiammetta Bozzani and Susmita Chatterjee and Nicola Foster and Baena, {Ines Garcia} and Laurence, {Yoko V.} and Sun Qiang and Andrew Siroka and Sedona Sweeney and St{\'e}phane Verguet and Nimalan Arinaminpathy and Andrew Azman and Eran Bendavid and Chang, {Stewart T.} and Ted Cohen and Denholm, {Justin T.} and Dowdy, {David Wesley} and Eckhoff, {Philip A.} and Goldhaber-Fiebert, {Jeremy D.} and Andreas Handel and Huynh, {Grace H.} and Marek Lalli and Lin, {Hsien Ho} and Sandip Mandal and McBryde, {Emma S.} and Surabhi Pandey and Salomon, {Joshua A.} and Suen, {Sze chuan} and Tom Sumner and Trauer, {James M.} and Wagner, {Bradley G.} and Whalen, {Christopher C.} and Wu, {Chieh Yin} and Delia Boccia and Chadha, {Vineet K.} and Salome Charalambous and Chin, {Daniel P.} and Gavin Churchyard and Colleen Daniels and Puneet Dewan and Lucica Ditiu and Eaton, {Jeffrey W.} and Grant, {Alison D.} and Piotr Hippner and Mehran Hosseini and David Mametja and Carel Pretorius and Yogan Pillay and Kiran Rade and Suvanand Sahu and Lixia Wang and Houben, {Rein M G J} and Kimerling, {Michael E.} and White, {Richard G.} and Anna Vassall",
year = "2016",
month = "11",
day = "1",
doi = "10.1016/S2214-109X(16)30265-0",
language = "English (US)",
volume = "4",
pages = "e816--e826",
journal = "The Lancet Global Health",
issn = "2214-109X",
publisher = "Elsevier BV",
number = "11",

}

TY - JOUR

T1 - Cost-effectiveness and resource implications of aggressive action on tuberculosis in China, India, and South Africa

T2 - a combined analysis of nine models

AU - Menzies, Nicolas A.

AU - Gomez, Gabriela B.

AU - Bozzani, Fiammetta

AU - Chatterjee, Susmita

AU - Foster, Nicola

AU - Baena, Ines Garcia

AU - Laurence, Yoko V.

AU - Qiang, Sun

AU - Siroka, Andrew

AU - Sweeney, Sedona

AU - Verguet, Stéphane

AU - Arinaminpathy, Nimalan

AU - Azman, Andrew

AU - Bendavid, Eran

AU - Chang, Stewart T.

AU - Cohen, Ted

AU - Denholm, Justin T.

AU - Dowdy, David Wesley

AU - Eckhoff, Philip A.

AU - Goldhaber-Fiebert, Jeremy D.

AU - Handel, Andreas

AU - Huynh, Grace H.

AU - Lalli, Marek

AU - Lin, Hsien Ho

AU - Mandal, Sandip

AU - McBryde, Emma S.

AU - Pandey, Surabhi

AU - Salomon, Joshua A.

AU - Suen, Sze chuan

AU - Sumner, Tom

AU - Trauer, James M.

AU - Wagner, Bradley G.

AU - Whalen, Christopher C.

AU - Wu, Chieh Yin

AU - Boccia, Delia

AU - Chadha, Vineet K.

AU - Charalambous, Salome

AU - Chin, Daniel P.

AU - Churchyard, Gavin

AU - Daniels, Colleen

AU - Dewan, Puneet

AU - Ditiu, Lucica

AU - Eaton, Jeffrey W.

AU - Grant, Alison D.

AU - Hippner, Piotr

AU - Hosseini, Mehran

AU - Mametja, David

AU - Pretorius, Carel

AU - Pillay, Yogan

AU - Rade, Kiran

AU - Sahu, Suvanand

AU - Wang, Lixia

AU - Houben, Rein M G J

AU - Kimerling, Michael E.

AU - White, Richard G.

AU - Vassall, Anna

PY - 2016/11/1

Y1 - 2016/11/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84992397204&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84992397204&partnerID=8YFLogxK

U2 - 10.1016/S2214-109X(16)30265-0

DO - 10.1016/S2214-109X(16)30265-0

M3 - Article

C2 - 27720689

AN - SCOPUS:84992397204

VL - 4

SP - e816-e826

JO - The Lancet Global Health

JF - The Lancet Global Health

SN - 2214-109X

IS - 11

ER -