16. Tuberculosis

• The cost effectiveness of TB control depends not only on local costs but also on the local characteristics of TB epidemiology (for example, epidemic or endemic, low or high rates of HIV infection and drug resistance) and on the rate of application of any chosen intervention.

• Short-course chemotherapy for the treatment of infectious and noninfectious TB patients through the DOTS strategy is highly cost-effective for the control of either epidemic or endemic TB (US$5 to US$50 per DALY gained, for regions excluding Eastern and Central Europe). When a new treatment program is compared with a previous program, DOTS often saves money as well as preventing cases and deaths.

• Some variations on DOTS are less cost-effective but still good value for money, including the treatment of patients with MDR-TB (standard or individualized drug regimens) and with HIV infection (with or without supporting antiretroviral therapy). For these additional interventions, the cost per DALY gained is less than the annual average economic productivity per capita in the least developed countries.

• Even with relatively favorable assumptions, the treatment of latent TB infection where TB is endemic and populations are unaffected by HIV is the least cost-effective of the interventions examined here (US$5,500 to US$26,000 per DALY gained). TLTI is more cost-effective during outbreaks (US$150 to US$500 per DALY gained) and for people who are coinfected with TB and HIV (US$15 to US$300 per DALY gained).

• BCG vaccination to prevent severe forms of childhood TB is much less effective than SCC but nearly as cost-effective (US$40 to US$170 per DALY gained).

• A new vaccine that prevents pulmonary TB with high efficacy (equal to or greater than 75 percent) would be more cost-effective than BCG if the cost of immunization were the same as BCG (US$20 to US$100 per DALY gained).

• For any intervention with the potential to cut transmission (that is, excluding BCG vaccination), control of epidemic disease produces more favorable cost-effectiveness ratios than control of endemic disease, because the benefits gained from reduced transmission are greater during outbreaks.

Source: Authors.