Curbing Global Tuberculosis: Saving Lives and Reaping Economic Benefits

Jun 30, 2009 | Peter Nelson

Despite advances in detection and treatment, roughly 9.2 million new tuberculosis (TB) cases and 1.7 million TB-related deaths were reported in 2006, mostly in sub-Saharan African and parts of Asia and eastern Europe. The scourge of TB causes severe economic distress for families and drastic losses in productivity for afflicted nations.

A diverse international network—the Global Plan to Stop TB—proposes to significantly increase resources devoted to fighting tuberculosis. It would incorporate proven treatment methods and other interventions in nations where TB is prevalent in order to meet the United Nations Millennium Development Goals for the disease. But, would the economic benefits of the additional effort outweigh the costs of implementation?

According to an article published in the journal Health Affairs, RFF Senior Fellow Ramanan Laxminarayan and co-authors report that in sub-Saharan Africa, the answer is yes. In this region, when the Global Plan is compared to continuing the current anti-TB strategy, the benefits of the Global Plan would outweigh its costs by a ratio of 9 to 1.

The article, entitled “Economic Benefits of Global Investments in Tuberculosis Control,” is available online at the Health Affairs website.

However, the benefit-to-cost ratio of the Global Plan would vary from country to country, the researchers say. The benefits of the Global Plan would unambiguously outweigh the costs in only 12 of the 22 countries with the highest TB-related burden: the nine high-burden countries in Africa plus Afghanistan, Pakistan, and Russia, according to Laxminarayan and his co-authors from RFF and the World Bank. Their results are based an epidemiological and economic model that projects TB incidence and mortality under various approaches and calculates the economic costs of additional treatment and monitoring versus the economic benefit of averting TB-related deaths.

“The reason for the mixed picture regarding the benefits and costs of the Global Plan is actually good news: many of the tools that the Global Plan would use have already been deployed by the international community and have greatly improved case detection and treatment,” explained Laxminarayan. Specifically, the World Health Organization has developed a multicomponent anti-TB strategy known as DOTS. Because one of the biggest obstacles to fighting TB is patient failure to complete treatment regimens, DOTS includes “directly observed treatment,” in which the patient takes his or her medication in front of a health care professional. DOTS also includes short-course chemotherapy and several other components.

The DOTS strategy has reduced the number of TB cases from just under 300 per 100,000 in 1990 to fewer than 220 per 100,000 in 2006, while mortality has decreased from 28 per 100,000 to 25 per 100,000 per year. The Global Plan would seek to improve case detection and treatment even further through methods such as community-based case detection, improved diagnosis and management of patients with respiratory symptoms due to TB, and improved collaboration between the public and private health sectors. When Laxminarayan and coauthors compared the DOTS strategy and the Global Plan against pre-DOTS anti-TB efforts, they found large positive benefit-to-cost ratios for all 22 high-burden countries in both cases.

For more information, read a related press release.