Evidence map›Paper›PMID 27720689›Full record

ArticleThe Lancet. Global health2016

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

Nicolas A Menzies, Gabriela B Gomez, Fiammetta Bozzani, Susmita Chatterjee, Nicola Foster, Ines Garcia Baena, Yoko V Laurence, Sun Qiang, Andrew Siroka, Sedona Sweeney and 46 more

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Article in The Lancet. Global health, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 62 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
62citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

62 citing papers in PubMed, 4 syntheses or guidelines pooled it.

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  11. RNA vaccines: The dawn of a new age for tuberculosis?Human vaccines & immunotherapeutics · 2025
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2 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

56 authors.

Nicolas A MenziesDepartment of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Center for Health Decision Science, Harvard T H Chan School of Public Health, Boston, MA, USA. Electronic address: nmenzies@hsph.harvard.edu.
Gabriela B GomezAmsterdam Institute for Global Health and Development, Amsterdam, Netherlands; Department of Global Health, Academic Medical Center, University of Amsterdam, Netherlands; Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
Fiammetta BozzaniDepartment of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
Susmita ChatterjeePublic Health Foundation of India, Delhi NCR, India.
Nicola FosterHealth Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Ines Garcia BaenaMonitoring and Evaluation Unit, Geneva, Switzerland.
Yoko V LaurenceDepartment of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
Sun QiangSchool of Health Care Management and Key Laboratory of Health Economics and Policy Research of Ministry of Health, Shandong University, Jinan, China.
Andrew SirokaGlobal TB Programme, Geneva, Switzerland.
Sedona SweeneyDepartment of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
Stéphane VerguetDepartment of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
Nimalan ArinaminpathyPublic Health Foundation of India, Delhi NCR, India; Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
Andrew S AzmanDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Eran BendavidDepartment of Medicine, Stanford University, Stanford, CA, USA.
Stewart T ChangInstitute for Disease Modeling, Seattle, WA, USA.
Ted CohenDepartment of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
Justin T DenholmVictorian Tuberculosis Program at the Peter Doherty Institute, Melbourne, VIC, Australia; Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia.
David W DowdyDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Philip A EckhoffInstitute for Disease Modeling, Seattle, WA, USA.
Jeremy D Goldhaber-FiebertStanford Health Policy, Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA.
Andreas HandelDepartment of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA.
Grace H HuynhInstitute for Disease Modeling, Seattle, WA, USA; Synthetic Neurobiology Group, Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA.
Marek LalliTB Modelling Group, TB Centre, London School of Hygiene & Tropical Medicine, London, UK; Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK.
Hsien-Ho LinInstitute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
Sandip MandalPublic Health Foundation of India, Delhi NCR, India.
Emma S McBrydeVictorian Tuberculosis Program at the Peter Doherty Institute, Melbourne, VIC, Australia; Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia; Burnet Institute, Melbourne, VIC, Australia.
Surabhi PandeyPublic Health Foundation of India, Delhi NCR, India.
Joshua A SalomonDepartment of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Center for Health Decision Science, Harvard T H Chan School of Public Health, Boston, MA, USA.
Sze-Chuan SuenDepartment of Management Science and Engineering, Stanford University, Stanford, CA, USA.
Tom SumnerTB Modelling Group, TB Centre, London School of Hygiene & Tropical Medicine, London, UK; Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK.
James M TrauerVictorian Tuberculosis Program at the Peter Doherty Institute, Melbourne, VIC, Australia; Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia; Burnet Institute, Melbourne, VIC, Australia.
Bradley G WagnerInstitute for Disease Modeling, Seattle, WA, USA.
Christopher C WhalenDepartment of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA.
Chieh-Yin WuInstitute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
Delia BocciaFaculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK.
Vineet K ChadhaEpidemiology and Research Division, National Tuberculosis Institute, Bangalore, India.
Salome CharalambousAurum Institute, Johannesburg, South Africa.
Daniel P ChinBill & Melinda Gates Foundation, Seattle, WA, USA.
Gavin ChurchyardDepartment of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; Aurum Institute, Johannesburg, South Africa; School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
Colleen DanielsStop TB Partnership, Geneva, Switzerland.
Puneet DewanBill & Melinda Gates Foundation, New Delhi, India.
Lucica DitiuStop TB Partnership, Geneva, Switzerland.
Jeffrey W EatonDepartment of Infectious Disease Epidemiology, Imperial College London, London, UK.
Alison D GrantDepartment of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; School of Public Health, University of Witwatersrand, Johannesburg, South Africa; Africa Centre for Population Health, School of Nursing & Public Health, University of KwaZulu-Natal, Durban, South Africa.
Piotr HippnerAurum Institute, Johannesburg, South Africa.
Mehran HosseiniStrategic Information Department, The Global Fund, Geneva, Switzerland.
David MametjaNational Department of Health, Pretoria, South Africa.
Carel PretoriusAvenir Health, Glastonbury, CT, USA.
Yogan PillayNational Department of Health, Pretoria, South Africa.
Kiran RadeWorld Health Organization Country Office for India, New Delhi, India.
Suvanand SahuStop TB Partnership, Geneva, Switzerland.
Lixia WangNational Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Rein M G J HoubenTB Modelling Group, TB Centre, London School of Hygiene & Tropical Medicine, London, UK; Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK.
Michael E KimerlingKNCV Tuberculosis Foundation, The Hague, Netherlands.
Richard G WhiteTB Modelling Group, TB Centre, London School of Hygiene & Tropical Medicine, London, UK; Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK.
Anna VassallDepartment of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.

Funding

CORE--PROGRAM DEVELOPMENTP30AG017253 · NIA · STANFORD UNIVERSITY · PI BHATTACHARYA, JAY · 1999 to 2019
$5.8M
Community Transmission of Tuberculosis Urban AfricaR01AI093856 · NIAID · UNIVERSITY OF GEORGIA · PI WHALEN, CHRISTOPHER C. · 2012 to 2021
$5.7M
Evaluating health and economic effects of targeted strategies in TB/HIVR01AI112438 · NIAID · YALE UNIVERSITY · PI COHEN, THEODORE H, SALOMON, JOSHUA A · 2014 to 2017
$2.4M
Cost-effective chronic disease prevention in developing countriesK01AG037593 · NIA · STANFORD UNIVERSITY · PI GOLDHABER-FIEBERT, JEREMY DAVID · 2011 to 2015
$637k
Medical Research Council MR/J005088/1Medical Research Council MR/K010174/1NIAID NIH HHS R01 AI093856NIAID NIH HHS R01 AI112438NIA NIH HHS K01 AG037593NIA NIH HHS P30 AG017253World Health Organization 001
6 · The paper itself

Abstract

backgroundThe 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.

methodsWe 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.

findingsIncremental 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.

interpretationExpansion 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.

fundingBill & Melinda Gates Foundation.

Indexed as

Cost-Benefit AnalysisDelivery of Health CareHealth Care CostsHealth ResourcesHealth Services Needs and DemandQuality-Adjusted Life YearsChinaForecastingGoalsHealth ExpendituresHealth PolicyHealth Services AccessibilityHumansIndiaModels, TheoreticalPatient Acceptance of Health Care

Identifiers

PMID27720689
PMCPMC5527122

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.