16. Tuberculosis

Abstract

Despite the availability of effective drugs, tuberculosis (TB) remains a significant cause of death from an infectious agent worldwide, second only to human immunodeficiency virus (HIV). Globally, TB incidence appears to be growing slowly. While case numbers are declining in Western and Central Europe, the Americas, and the Middle East, they have shown striking increases in Eastern Europe and Sub–Saharan Africa.

The cost–effectiveness of short–course chemotherapy for TB has been central to the global promotion of DOTS (directly observed treatment short course0 by the World Health Organization. However, the DOTS approach alone may not be sufficient to bring TB under control, and interest is growing in other methods, such as developing a more effective vaccine, treatment for latent TB infection, testing for TB drug resistance, treating HIV coinfection, and active case finding.

It is not clear how money can be best allocated for TB control; although DOTS programs are a good value, their full cost may be greater in countries where a broader investment in the health sector is needed. Further, traditional cost–effectiveness analysis of individual interventions does not solve the practical problem of how to allocate money to TB control in combination with other health interventions or even how to combine different approaches to TB control. Mathematical models can be used to generate simple and general formulas that relate reward to effort in the management of both epidemic and endemic TB.