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

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-eff ectiveness 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 eff ects (ie, disability-adjusted lifeyears averted) and resource implications for 2016–35, including patient-incurred costs. To assess resource requirements and cost-eff ectiveness, we compared scenarios with a base case representing continued current practice.

Findings: Incremental tuberculosis service costs diff ered 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-eff ectiveness thresholds, most intervention approaches seemed highly cost-eff ective. Interpretation: Expansion of tuberculosis services seems cost-eff ective for high-burden countries and could generate substantial health and economic benefi ts 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.