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Peer-reviewedCC BY 4.0Nature Health

Global impact and cost-effectiveness of tuberculosis interventions

  • Katherine C. Horton1,2
  • Alvaro Schwalb1,2,3
  • Martin J. Harker1,2,4
  • Lara Goscé1,2,5
  • Elena Venero-Garcia1,2
  • Lily O’Brien1,2
  • Arkaprabha Gun1,2,6
  • Tom Sumner1,2
  • C. Finn McQuaid1,2
  • Rebecca A. Clark1,2
  • Tomos O. Prys-Jones1,2
  • Roel Bakker1,2,7
5 more authors
  • Yiran E. Liu8,9
  • Mmamapudi Kubjane10
  • Christian Lienhardt11,12
  • Richard G. White1,2
  • Rein M. G. J. Houben1,2
12 affiliations
  1. 1TB Modelling Group, TB Centre, LSHTM, London, UK
  2. 2Department of Infectious Disease Epidemiology, LSHTM, London, UK
  3. 3Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
  4. 4Global Health Economics Centre, LSHTM, London, UK
  5. 5Institute for Global Health, University College London, London, UK
  6. 6Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec Canada
  7. 7KNCV Tuberculosis Foundation, The Hague, Netherlands
  8. 8SEICHE Center for Health and Justice, Yale University School of Medicine, New Haven, CT USA
  9. 9Justice Collaboratory, Yale Law School, New Haven, CT USA
  10. 10Health Economics and Epidemiology Research Office, Wits Health Consortium, University of the Witwatersrand, Johannesburg, South Africa
  11. 11French Institute for Research in Sustainable Development (IRD), Montpellier, France
  12. 12FAST-TB, CRDF Global, Arlington, VA USA
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Abstract

While a range of interventions exists for tuberculosis (TB), their potential impact and cost-effectiveness are seldom directly compared across settings with different TB epidemiologies and structural drivers. Here we calibrated a deterministic TB model to epidemiological indicators from Brazil, India and South Africa. We implemented seven interventions across countries focusing on prevention, screening and diagnosis and treatment, as well as prison screening (Brazil) and nutritional supplementation (India). We standardized scale-up (2025–2030), coverage (80% of the target population) and strength of evidence using published efficacy data. We estimated the epidemiological impact and incremental cost-effectiveness ratios (ICERs), expressed as costs per disability-adjusted life year (DALY) averted, through 2050. Only three interventions prevented >10% of incident TB episodes by 2050: vaccination (median 15–28% across countries), symptom-agnostic community-wide screening (31–38%) and prison screening (23%). Other interventions had limited impact, ranging from 0% (shorter drug-susceptible treatment) to 5% (nutritional supplementation). ICERs varied widely by intervention and setting. Shorter drug-resistant treatment was cost-saving across settings, with the next lowest ICERs for prison screening (US$146 per DALY) and nutritional supplementation (US$281 per DALY). Interventions with meaningful epidemiological impact can be cost-effective but must target populations beyond clinic-diagnosed individuals and their households. Achieving such potential requires a shift in priorities regarding funding, policy and product development.

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Cite

BibTeXRIS
BibTeX
@article{horton2026global,
  title = {{Global impact and cost-effectiveness of tuberculosis interventions}},
  author = {Katherine C. Horton and Alvaro Schwalb and Martin J. Harker and Lara Goscé and Elena Venero-Garcia and Lily O’Brien and Arkaprabha Gun and Tom Sumner and C. Finn McQuaid and Rebecca A. Clark and Tomos O. Prys-Jones and Roel Bakker and Yiran E. Liu and Mmamapudi Kubjane and Christian Lienhardt and Richard G. White and Rein M. G. J. Houben},
  journal = {Nature Health},
  year = {2026},
  month = jul,
  doi = {10.1038/s44360-026-00171-5},
  url = {https://doi.org/10.1038/s44360-026-00171-5},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Global impact and cost-effectiveness of tuberculosis interventions
AU  - Katherine C. Horton
AU  - Alvaro Schwalb
AU  - Martin J. Harker
AU  - Lara Goscé
AU  - Elena Venero-Garcia
AU  - Lily O’Brien
AU  - Arkaprabha Gun
AU  - Tom Sumner
AU  - C. Finn McQuaid
AU  - Rebecca A. Clark
AU  - Tomos O. Prys-Jones
AU  - Roel Bakker
AU  - Yiran E. Liu
AU  - Mmamapudi Kubjane
AU  - Christian Lienhardt
AU  - Richard G. White
AU  - Rein M. G. J. Houben
PY  - 2026
DA  - 2026/07/21
JO  - Nature Health
DO  - 10.1038/s44360-026-00171-5
UR  - https://doi.org/10.1038/s44360-026-00171-5
AB  - While a range of interventions exists for tuberculosis (TB), their potential impact and cost-effectiveness are seldom directly compared across settings with different TB epidemiologies and structural drivers. Here we calibrated a deterministic TB model to epidemiological indicators from Brazil, India and South Africa. We implemented seven interventions across countries focusing on prevention, screening and diagnosis and treatment, as well as prison screening (Brazil) and nutritional supplementation (India). We standardized scale-up (2025–2030), coverage (80% of the target population) and strength of evidence using published efficacy data. We estimated the epidemiological impact and incremental cost-effectiveness ratios (ICERs), expressed as costs per disability-adjusted life year (DALY) averted, through 2050. Only three interventions prevented >10% of incident TB episodes by 2050: vaccination (median 15–28% across countries), symptom-agnostic community-wide screening (31–38%) and prison screening (23%). Other interventions had limited impact, ranging from 0% (shorter drug-susceptible treatment) to 5% (nutritional supplementation). ICERs varied widely by intervention and setting. Shorter drug-resistant treatment was cost-saving across settings, with the next lowest ICERs for prison screening (US$146 per DALY) and nutritional supplementation (US$281 per DALY). Interventions with meaningful epidemiological impact can be cost-effective but must target populations beyond clinic-diagnosed individuals and their households. Achieving such potential requires a shift in priorities regarding funding, policy and product development.
SN  - 3005-0693
ER  -