In post-2015 End TB strategy, tuberculosis incidence and mortality is targeted to reduce 50 percent and 75 percent respectively by 2025. Dr. Hsien-Ho Lin and Ms. Chieh-Yin Wu, both from the College of Public Health at National Taiwan University, participated a joint modelling project to assess these targets in South Africa, China and India. There are 11 modelling groups in this project convened by TB Modelling and Analysis Consortium. Although the models varied in frameworks, population and stratification setting, all of them were calibrated to the specific targets of tuberculosis epidemic burden.
With a combination of continuous prevention, case finding, and improvements in care, the model projections showed a median of 55 percent (31-62 percent) and 72 percent (65-82 percent) reduction in incidence and mortality respectively in South Africa. It seemed that the 2025 WHO targets can be achieved in South Africa. However, in China and India, small proportional reductions were projected. Additional interventions, such as tackling latent tuberculosis infection in elderly people in China and reducing undernutrition in India, are needed to meet the post-2015 targets.
The group also conducted cost-effectiveness analysis on scaling up intervention scenarios, including expansion of access to care, improvement of treatment and strategy of active case finding or new diagnosis, motivated by End-TB strategy. It was estimated by considering DALY averted and incremental costs under several perspectives from different character. “In all three countries, expansion of access to care produced substantial health gains.”, the research team revealed in the article.
A significant highlight from the two articles is the collaboration of 11 independent modelling groups with variations in model structure and parameter values, with consistent finding which is rather convincing. “The consistent finding of substantial savings for patients is a reminder that reducing the tuberculosis burden is all about reducing the burden on patients”, commented Olivia Oxlade and Dick Menzies. “In addition, perhaps the goal of ending tuberculosis is not such an impossible dream.”