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 S. Azman, Eran Bendavid, Stewart T. Chang, Ted Cohen, Justin T. Denholm, David W. 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 journalArticlepeer-review


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
Issue number11
StatePublished - Nov 1 2016

ASJC Scopus subject areas

  • Medicine(all)

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