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

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• 作者：Prof Nicolas A Menzies ; PhD^a ; ^b ; ^{nmenzies@hsph.harvard.edu" class="auth_mail" title="E-mail the corresponding author} ; Gabriela B Gomez ; PhD^c ; ^d ; ^e ; Fiammetta Bozzani ; MSc^e ; Susmita Chatterjee ; PhDⁱ ; Nicola Foster ; MPH^j ; Ines Garcia Baena ; MSc^k ; Yoko V Laurence ; MSc^e ; Prof Sun Qiang ; PhD^m ; Andrew Siroka ; PhD^l ; Sedona Sweeney ; MSc^e ; Sté ; phane Verguet ; PhD^a ; Nimalan Arinaminpathy ; DPhilⁱ ; ⁿ ; Andrew S Azman ; PhD^o ; Eran Bendavid ; MD^p ; Stewart T Chang ; PhD^s ; Prof Ted Cohen ; DPH^t ; Justin T Denholm ; PhD^u ; ^v ; David W Dowdy ; MD^o ; Philip A Eckhoff ; PhD^s ; Jeremy D Goldhaber-Fiebert ; PhD^r ; Andreas Handel ; PhD^w ; Grace H Huynh ; PhD^s ; ^x ; Marek Lalli ; MSc^f ; ^g ; Hsien-Ho Lin ; ScD^y ; Sandip Mandal ; PhDⁱ ; Emma S McBryde ; PhD^u ; ^v ; ^z ; Surabhi Pandey ; PhDⁱ ; Prof Joshua A Salomon ; PhD^a ; ^b ; Sze-chuan Suen ; MS^q ; Tom Sumner ; PhD^f ; ^g ; James M Trauer ; MBBS^u ; ^v ; ^z ; Bradley G Wagner ; PhD^s ; Prof Christopher C Whalen ; MD^w ; Chieh-Yin Wu ; MS^y ; Delia Boccia ; PhD^g ; Vineet K Chadha ; MD^aa ; Salome Charalambous ; PhD^ab ; Daniel P Chin ; MD^ac ; Prof Gavin Churchyard ; PhD^h ; ^ab ; ^ad ; Colleen Daniels ; MA^ae ; Puneet Dewan ; MD^af ; Lucica Ditiu ; MD^ae ; Jeffrey W Eaton ; PhDⁿ ; Prof Alison D Grant ; PhD^h ; ^ad ; ^ag ; Piotr Hippner ; MSc^ab ; Mehran Hosseini ; MD^ah ; David Mametja ; MPH^ai ; Carel Pretorius ; PhD^aj ; Yogan Pillay ; PhD^ai ; Kiran Rade ; MD^ak
• 刊名：The Lancet Global Health
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：4
• 期：11
• 页码：e816-e826
• 全文大小：1142 K

文摘

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.